Senior Manager, Medicaid Compliance

Job not on LinkedIn

🕒 August 20

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $75.4k - $166k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

👻 Ghost score 23%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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

• Manage, execute, and oversee compliance program activities and deliverables for a Medicaid managed care organization • Serve as the designated Compliance Officer for Aetna’s Ohio Medicaid health plan • Oversee compliance team members assigned to the Ohio market • Liaise with the state Medicaid agency on compliance and contract-related communications and activities • Track, monitor, review, and submit regulatory and compliance deliverables and responses • Prepare and oversee complex regulatory reports and deliverables • Facilitate external Medicaid audits through final reports and corrective action plan closure • Lead and execute all elements of the Medicaid compliance program • Research and develop recommendations for compliant business operations, processes, and policies • Develop compliance communications responding to state Medicaid agency inquiries • Maintain knowledge of contractual, regulatory, and program policy obligations • Maintain compliance tools, contract libraries, reporting assignments, risk assessments, tracking lists, and internal reporting systems • Identify risks, conduct oversight and monitoring, and support mitigation and corrective action plans • Use Microsoft products and Archer; maintain documentation, train users, and contribute to system design, oversight, or maintenance • Communicate with and influence senior internal and external constituents • Provide training and guidance to less experienced team members • Perform other duties as assigned

🎯 Requirements

• Candidate must reside in the state of Ohio • 7+ years of regulatory compliance experience in managed care, health care, or insurance • 2+ years of project management experience • Bachelor’s Degree preferably in Public Policy, Government Affairs, Health Care Administration, or Public Administration; required or equivalent years of related professional work experience • Experience with Medicaid or Medicaid managed care preferred • Audit experience preferred • Proficiency with Microsoft products • Experience with compliance-specific tools such as Archer • Master’s degree or Juris Doctor preferred

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Award target in the company’s equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being