Senior Manager, Medicaid Compliance

Job not on LinkedIn

🔥 0 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $75.4k - $166k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

👻 Ghost score 0%

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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

• Serve as designated Compliance Officer for Aetna’s Ohio Medicaid health plan • Manage, execute, and oversee compliance program activities and deliverables • Oversee compliance team members assigned to the Ohio market • Act as primary liaison to the state Medicaid agency • Track, monitor, review, and submit regulatory and compliance deliverables and responses • Prepare and oversee complex regulatory reports and deliverables • Facilitate preparation for and management of external audits through report 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 compliance tools, contract libraries, reporting assignments, risk assessments, and tracking systems • Identify risks and conduct oversight and monitoring across the business • Support mitigation and corrective action plans and escalate risks and concerns • Use and maintain Microsoft and Archer systems, documentation, and system design or maintenance • Maintain relationships with internal and external senior-level constituents • Provide training and guidance to less experienced team members • Perform other duties as assigned

🎯 Requirements

• 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 • Microsoft products • Archer or similar compliance-specific tools • Ability to serve as designated Compliance Officer for Aetna’s Ohio Medicaid health plan • Ability to manage, execute, and oversee Medicaid compliance program activities and deliverables • Ability to maintain knowledge of contractual, regulatory, and program policy obligations • Ability to train and guide less experienced team members

🏖️ 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