Senior Manager, Medicaid Compliance - MI

CVS Health • Southfield, MI

8d • $75,400 - $165,954

About The Position

The Senior Manager of Medicaid Compliance manages, executes, and oversees compliance program activities and deliverables for a Medicaid managed care organization operating in a moderately complex regulatory environment. The role serves as the designated Compliance Officer for Aetna’s Michigan Medicaid health plan and oversees other compliance team members assigned to the MI market. It develops and maintains systems and processes that support an effective compliance program and promote compliant and ethical behavior.

Requirements

• At least 7 years of regulatory compliance experience in managed care, health care, or insurance.
• At least 2 years of project management experience.
• Bachelor’s degree or equivalent years of related professional work experience.

Nice To Haves

• Experience with Medicaid or Medicaid managed care.
• Audit experience.
• Master’s degree or Juris Doctor.

Responsibilities

• Serve as the primary liaison to the state Medicaid agency for compliance- and contract-related communications and activities.
• Maintain systems and tools to track, monitor, review, and submit regulatory and compliance deliverables and responses to state Medicaid agencies by required due dates; prepare and oversee complex regulatory reports and deliverables as needed.
• Facilitate preparation for and management of external audits conducted by state Medicaid and related agencies or partners, through final reports and corrective action plan closure.
• Lead and execute all elements of the Medicaid compliance program for Aetna’s Michigan Medicaid health plan.
• Research requirements and develop recommendations for compliant business operations, processes, and policies that meet state-specific Medicaid program requirements.
• Develop strategic and appropriate compliance communications for the health plan in response to state Medicaid agency inquiries or requests.
• Maintain in-depth knowledge of the health plan’s contractual, regulatory, and program policy obligations; provide education, training, and decision-making support to health plan and growth partner staff.
• Keep compliance resource tools and internal deliverables current and accessible, including the contract library, regulatory reporting assignments, risk assessments, risk tracking lists, internal reporting systems, and summaries.
• Identify areas of risk or concern, conduct oversight and monitoring, support business partners in developing mitigation and corrective action plans, and escalate risks and issues through appropriate channels.
• Use job-specific systems, including Microsoft products and Archer; maintain system documentation, serve as a subject matter expert, train users, and contribute to system design, oversight, or maintenance.
• Lead and direct oversight and monitoring activities to evaluate compliance with new and existing Medicaid managed care organization requirements.
• Maintain productive relationships with internal and external senior-level constituents to communicate and influence ethical and compliant outcomes.
• Train and guide less experienced team members to accomplish goals.
• Perform other duties as assigned.

Benefits

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.
• Eligibility for a CVS Health bonus, commission, or short-term incentive program.
• An award target in the company’s equity award program.

What This Job Offers

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