Senior Manager, Corporate Compliance (Medicare Duals)

Sr. Manager Compliance

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary : The Sr. Manager is an experienced / career level compliance position that applies compliance, regulatory, business, analytical and communication skills to support, manage and develop and execute Medicare and Medicaid compliance programs and processes that promote compliant and ethical behavior, meet regulatory obligations, and prevent, detect and mitigate compliance risks. The individual will 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.

The Sr. Manager Compliance maintains 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.

Responsibilities include, but are not limited to :

• 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

In order to be successful in this role you must exhibit the following :

Required Qualifications :

Preferred Qualifications :

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

Education : Bachelor's Degree required

Pay Range : The typical pay range for this role is : $82,940.00 - $182,549.00

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include :

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