Director, Medicaid Regulatory Affairs

CVS Health•Columbia, MD

6d•$100,000 - $231,540•Hybrid

About The Position

The Aetna Better Health of Maryland (ABHMD) Director of Medicaid Regulatory Affairs plays a key role on the ABHMD leadership team and the Maryland Department of Health (MDH). The Director of Medicaid Regulatory Affairs serves as the ABHMD Government Liaison. The Director of Regulatory Affairs will work in close partnership with the CEO, ABHMD Executive Leadership Team (ELT) and all matrixed shared service partners to effectively sustain and grow ABHMD membership and ensure the operating efficiency and financial strength of the program. The Director will be the primary senior leader responsible for ongoing program communications and coordination with MDH on behalf of ABHMD. This role is the primary bridge between the health plan and government entities like the Maryland Department of Health, Centers for Medicare & Medicaid Services and, acts as the right hand to the Aetna Better Health of Maryland CEO, while focusing on internal execution and external strategic alignment, while also focusing internally on keeping the Aetna Better Health of Maryland’s operations aligned and running to secure the plan's licensing, navigate policy changes, and maintain the Plan’s MCO contract.

Requirements

7+ years in Medicaid managed care contracting, compliance, or regulatory affairs
Knowledge of Maryland legislative, administrative, and regulatory processes.
Experience with relevant stakeholders including the Maryland Department of Health for Medicaid Services and Maryland medical provider community
Maryland Medicaid (HealthChoice) regulatory experience
Strong analytical skills and diligence, including interpreting and executing regulatory and contractual language.
Effective communication skills, both written and verbal
Strong political acumen with ability to effectively interact with State partners.
Excellent organization and time management skills
Understanding of health plan operations, including contracting, claims processing, encounter data processing, and Medicaid eligibility and enrollment.
Experience navigating a matrixed organization.
Experience developing and executing project plans and processes.

Nice To Haves

We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week. Aetna Service Operations office/hub locations will be discussed with the selected candidate

Responsibilities

Interprets and implements complex Medicaid regulations and ensures the Aetna Better Health of Maryland adheres to them.
Serves as the key liaison to state and federal regulators, managing filings, audits, and policy negotiations while supplying regulatory updates to plan leadership on all State and Federal rulemaking and contract communications.
Identifies upcoming regulatory shifts and develops organizational strategies to adapt without service interruption.
Translates the CEO's vision, State and Federal regulatory requirements into actionable, day-to-day goals for the Aetna Better Health of Maryland health plan departments.
Coordinates initiatives across different departments (e.g., Clinical, Finance, Provider Relations, and Legal).
Under the direction of the CEO, manages high-priority projects and acts as an advisor and gatekeeper for the Aetna Better Health of Maryland executive team.
Develops and manages project plans to implement State contract amendments, fields, and coordinates responses to State inquiries and participates in state meetings, summarizes results and action items.
Prepares all state filings on innovative programs/vendors for State submission and approval.