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Position Summary

Executive level compliance position that is responsible for the management, execution, and oversight of the compliance program activities and deliverables for a large portfolio of Aetna’s Medicaid managed care health plans operating in a highly complex regulatory environment. Oversees the activities of the Medicaid compliance program and market-specific compliance officers and other compliance staff for an assigned regional division. This position is responsible for developing and maintaining systems and processes that demonstrate the principles of an effective Compliance program and promote compliant and ethical behavior in the assigned Medicaid health plan to meet all state and Federal requirements for Medicaid managed care.  In addition to regional oversight responsibilities, this role will also maintain a role as the designated Compliance Officer/Compliance Lead for one of the markets within the region.

You'll make an impact by:

• Independently oversee the compliance officers and compliance staff for an assigned large scale region/division of Aetna’s Medicaid business ($4B+ in revenue or 750K or more members);
• Conduct research and develop recommendations to help develop compliant business operations, processes and policies in accordance with state specific Medicaid program requirements
• Lead and manage consistent and effective execution of all elements of the Medicaid compliance program for assigned market as well as Aetna’s other Medicaid health plans in assigned region/division
• Develop and manage a robust team of compliance professionals to support the complex Medicaid regulatory and compliance environment in Aetna’s Medicaid health plans
• Drive process improvement, consistency and accuracy across Medicaid compliance deliverables and responsibilities for assigned region/division including:
  • Preparation for and management of Aetna’s participation and response to external audits conducted by state Medicaid and related agencies or partners through final report and corrective action plan closure
  • Development of compelling, strategic, and appropriate compliance related communications in response to state Medicaid agency inquiries or requests
  • Compliance staff maintenance of an in-depth working knowledge of the health plan’s contractual, regulatory, and program policy related obligations as a Medicaid managed care organization
  • Compliance staff partnership with health plan and growth partner staff for education, training, and business decision making purposes
  • Maintenance of 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 in a way that is accessible to business partners to promote compliant programs and processes
  • Targeted monitoring and oversight of health plan compliance with state Medicaid program requirements

Required Qualifications

• 10+ years previous experience in Medicaid or Medicaid managed care
• 5+ years previous management experience
• 7+ years regulatory compliance position in managed care, health care, or insurance
• Project Management experience
• Must reside in Texas, Oklahoma, or Arizona

Preferred Qualifications

• Direct experience managing regulatory affairs and/or compliance functions for a Medicaid managed care organization
• Audit preparation and response experience
• Masters degree in Public Policy, Health Care Administration, Public Administration or similar fields or a law degree

Education

• Bachelor's degree or equivalent experience in relevant field

Pay Range

The typical pay range for this role is:

$131,500.00 - $303,195.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.  This position also includes an award target in the company’s equity award program. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. 
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 09/20/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.