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CVS Health · 1 month ago

Senior Manager, Corporate Compliance (Medicare Duals)

Downers Grove, IL

Full-time

Onsite

Senior Level

$83K/yr - $183K/yr

7+ years exp

CVS Health is a leading health solutions company dedicated to transforming health care. The Senior Manager, Corporate Compliance will support, manage, and develop Medicare and Medicaid compliance programs, ensuring ethical behavior and regulatory obligations are met while maintaining productive relationships with stakeholders.

Health CareMedicalPharmaceuticalRetailSales

Responsibilities

Serve as plan compliance officer for assigned Special Needs Plans (SNPs)

Lead and implement an effective Compliance Program as described in CMS Medicare Managed Care Manuals/regulations, applicable Medicaid rules and government contracts, 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 state regulations and government contract requirements to develop recommendations, direction, and escalation ensuring Aetna’s that implementation and integration of program requirements complies with federal and state specific program requirements and the CVS Code of Conduct

Maintain in-depth working knowledge and expertise in Medicare, Medicaid and State requirements, regulations and contracts with a focus on supporting special needs plans

Facilitate compliance and contract related communications, deliverables and activities with regulators

Manage to ensure timely and accurate responses and tracking of multiple complex regulatory interactions, including frequent meeting with regulators on compliance with laws and regulations, developing or assisting in the development of appropriate and strategic written responses to compliance-related regulatory inquiries requiring an understanding of business processes and regulatory requirements and positive relationships with regulators

Leads and/or supports numerous external regulatory review and audit activities, including the preparation for and management of external audits conducted by state Medicaid and related agencies or partners in conjunction with health plan leadership through final report and corrective action plan closure

Builds and maintains positive relationships with internal and external constituents 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

Utilize and maintain current information in systems unique to job functions, such as Microsoft products and compliance specific tools such as Archer

Lead and support broader compliance initiatives and needs as assigned to ensure that effective compliance programs are achieved and maintained

Work on other duties as assigned

Qualification

Medicare complianceMedicaid complianceProject ManagementRegulatory analysisAuditingMonitoringTime managementProblem solvingCollaboration

Required

7+ years' experience in Medicare or Medicare Advantage government healthcare program compliance or regulatory work

2+ years of Project Management experience

Ability to travel up to 10%

Extensive knowledge of Medicare and Medicaid compliance programs and rules, including rules applying to integrated duals plans

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

Bachelor's Degree required

Preferred

Extensive knowledge of Medicare and Medicaid compliance programs and rules, including rules applying to integrated duals plans

Benefits

Affordable medical plan options

401(k) plan (including matching company contributions)

Employee stock purchase plan

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching

Paid time off

Flexible work schedules

Family leave

Dependent care resources

Colleague assistance programs

Tuition assistance

Retiree medical access