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Position Summary

***This role follows a hybrid working schedule of three days onsite per week at one of our core locations (Scottsdale, AZ, Woonsocket, RI, Hartford, CT, Northbrook, IL, or Irving, TX)***

The Compliance Manager, FDR Oversight Program is an individual contributor career level position within Medicare Compliance who will execute operational and compliance program effectiveness reviews to support our FDR Oversight program.

In this role, they will support Medicare Compliance initiatives designed to ensure the seven (7) elements  of an effective compliance program as described in CMS’ Compliance Program Guidelines (Chapters 9 and 21) and other applicable regulations are met.  

A successful candidate will have the ability to:

• Work independently, as well as in collaboration with, colleagues from across the organization to monitor compliance strategies.

• Understands and can support the principles of an effective Compliance program, including, but not limited to, risk assessment, auditing, and monitoring, maintaining effective compliance policies and procedures, and effective communication and training.

• Independently identify and assess moderately complex compliance issues, communicate (oral or written) with others to discuss, and collaborate towards resolving the identified compliance issues.

• Manage multiple projects simultaneously, displaying strong organizational skills.

• Escalate risks and identified issues timely to leadership and work towards meaningful solutions.

Responsibilities:

• Serves as subject matter expert for our FDR Oversight program.

• Conducts oversight activities, as outlined in the Medicare Compliance Work Plan to verify compliance with Aetna standards and regulatory requirements.

• Applies compliance knowledge to address compliance issues, including evaluation of root cause analysis, recommends corrective action for compliance gaps, monitors completion and conducts validation of action plan effectiveness.

• With little to no guidance, obtains and reviews evidence ensuring oversight activity  results and work papers are clear, concise, well-documented, and retained in accordance with department guidelines.

• Independently identify and assess moderately complex compliance issues, communicates (oral or written) with leaders and others to discuss, and actively collaborates towards resolving the identified compliance issues.

• Works independently, as well as in collaboration with, colleagues from across the organization to assess compliance strategies.

• Assists with supporting and educating internal and external constituents in their understanding of FDR requirements, and the oversight processes, to comply with the regulatory requirements.

• Participates and presents at required oversight committees, as needed.

• Maintains current working knowledge and expertise in Medicare Compliance.

• Utilizes systems unique to job functions, including standard-issue Microsoft products and compliance specific tools such as Archer and QuickBase.

• Other duties as assigned.

Required Qualifications:

-5+ years of experience in government healthcare programs related to compliance or regulatory work

-3+ years of project management experience

-Ability to travel up to 10%

Preferred Qualifications:

• Experience with CMS and/or State Medicare/Medicaid audits

• Experience with administration of the FDR Requirements outlined in CMS’ Compliance Program Guidelines (Chapters 9 and 21)

• Project management experience

Education:

• Bachelor's degree required or equivalent professional years of experience

Pay Range

The typical pay range for this role is:

$60,300.00 - $145,860.00

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. 
 
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: 12/31/2024

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