Manager, Medicaid Compliance - Oklahoma

CVS Health•Oklahoma City, OK

5d•Onsite

About The Position

Experienced/career level compliance position that supports the compliance program activities and deliverables of a Medicaid managed care organization. In partnership with and under the direction of the health plan Compliance Officer, this position will help develop and maintain systems and processes that demonstrate the principles of an effective Compliance program and promote compliant and ethical behavior in the Oklahoma Medicaid health plans.

Requirements

Minimum of 5 years of regulatory compliance position in managed care, health care, or insurance
Project management experience

Nice To Haves

Experience with Medicaid or Medicaid managed care
Experience with audit coordination and policy management

Responsibilities

Maintain the systems and tools to track, monitor, review, and submit required regulatory and compliance related deliverables and responses to Oklahoma Medicaid agencies on or before required due dates; prepares moderately complex regulatory reports as needed on behalf of the Medicaid compliance team
Conduct research and develop recommendations to help develop compliant business operations, processes and policies in accordance with state specific Medicaid program requirements
Develop compelling and appropriate compliance related communications on behalf of the health plan in response to Oklahoma 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 and business decision making purposes
Manage and support the external audit review process in conjunction with designated subject matter experts at the health plan, including, but not limited to the project management and tracking of required deliverables, responses, and corrective action plan development (through closure)
Maintain 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 as needed 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
Conduct oversight and monitoring to evaluate levels of compliance with 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 constituents to effectively communicate and influence ethical and compliant outcomes
Provide training and guidance to less experienced team members to accomplish goals
Other duties as assigned