Manager, Medicare Compliance

CVS Health

8d

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: As a Medicare Compliance Manager, you are an experienced/career level compliance position that applies compliance, regulatory, business, analytical and communication skills to support, manage and develop and execute Medicare compliance programs and processes that promote compliant and ethical behavior, meet regulatory obligations, and prevent, detect and mitigate compliance risks. This role will allow you to work independently, as well as collaboratively, with internal senior level corporate compliance and business teams that operate Medicare Advantage in a highly complex regulatory environment and highly matrixed organization environment with a current focus on integrated special needs plans. You will maintain productive relationships and open lines of communication with internal and key external stakeholders to effectively communicate and influence compliant outcomes and ensure that processes are enhanced or implemented to effectively address compliance requirements.

Requirements

• Extensive knowledge of Medicare compliance programs and rules
• Experience in validation, auditing and monitoring, root cause analysis and corrective action oversight
• Outstanding time management and project management
• Proficient in utilization of information systems
• Mastery of problem solving and decision-making skills
• Adept at execution and delivery (planning, delivering, and supporting) skills
• Adept at collaboration and teamwork
• Minimum of 5 years’ experience in Medicare Compliance or regulatory work
• Willingness to travel up to 10% (including plane)

Nice To Haves

• Expertise in Medicare Appeals requirements
• 3+ years of Medicare Compliance work

Responsibilities

• Lead and implement an effective Compliance Program as described in CMS Medicare Managed Care Manuals/regulations, including risk assessment, auditing and monitoring and corrective action oversight.
• Develop and manage compliance strategies, programs, and processes that promote compliant and ethical behavior, meet regulatory obligations, and prevent, detect, and mitigate compliance risks.
• Track, analyze, research, interpret and monitor applicable CMS and to develop recommendations, direction, and escalation ensuring Aetna’s that implementation and integration of program requirements complies with federal and the CVS Code of Conduct
• Maintain in-depth working knowledge and expertise in Medicare regulations
• Builds and maintains positive relationships at senior levels to drive decision-making and influence ethical and compliant outcomes
• Monitor and audit as outlined in Medicare Compliance Work Plan and direct other projects as assigned to evaluate compliance, propose remediation where necessary and monitor implementation of corrective action
• Lead and support broader compliance initiatives and needs as assigned to ensure that effective compliance programs are achieved and maintained.
• Other duties as assigned.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager