Lead Director – Corporate Compliance

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🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $100k - $231.5k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Serve as the designated Compliance Officer for Aetna’s IL Medicaid health plan • Acts as the primary liaison to the state Medicaid agency, facilitating compliance and contract-related communications and activities. • Facilitates the preparation for and management of external audits conducted by state Medicaid and related agencies or partners • Lead and execute all elements of the Medicaid compliance program for Aetna’s IL Medicaid health plan. • Conduct research and develop recommendations to help develop compliant business operations, processes and policies in accordance with state specific Medicaid program requirements. • Develop compelling, strategic, and appropriate compliance related communications on behalf of the health plan in response to state Medicaid agency inquiries or requests. • Maintain an in-depth working knowledge of the health plan’s contractual, regulatory, and program policy related obligations as a Medicaid managed care organization and serve as a resource to health plan and growth partner staff for education, training, and business decision making purposes. • Ensure that current resource tools and other internal deliverables such as current contract library, regulatory reporting assignments, risk assessments, risk tracking lists, internal reporting systems and summaries, and other department wide tools are current and accessible to business partners to ensure the appropriate monitoring and oversight of health plan compliance processes. • Utilize systems unique to job functions, including standard-issue software such as Microsoft products and compliance specific tools such as Archer; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenance. • Lead and direct oversight and monitoring activities to evaluate levels of compliance with new and existing Medicaid managed care organization requirements across the business; support business partners in the development of mitigation and corrective action plans and effectively escalate risks, concerns and other issues through appropriate channels. • Maintain positive, productive relationships with internal and external senior level constituents to effectively communicate and influence ethical and compliant outcomes. • Oversee the submission of required regulatory reports (standard and ad hoc), including the completion of high level quality reviews prior to submission and the maintenance of tracking systems and tools to document ownership, reporting requirements, and monitor timely delivery and acceptance of reports. • Provide training and guidance to less experienced team members to accomplish goals. • Other duties as assigned.

🎯 Requirements

• 10+ years of previous experience in Medicaid or Medicaid managed care • 5+ years of roles that required use of project management skills and responsibilities • 2+ years of previous management experience • Audit experience • Master’s degree in Public Policy, Health Care Administration, Public Administration or similar fields or a law degree • Bachelors degree required or equivalent years of related experience.

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources