Description
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. *Position Summary* ****This position follows a hybrid working schedule of three days onsite and two days remote per week**** Experienced/career level compliance position that supports the compliance program activities and deliverables of a Medicaid managed care organization. In partnership with and under the direction of the Lead Director, National Medicaid Business Compliance Office (BCO), this position will help develop and maintain systems and processes for the management, execution, and oversight of the implementation of new state Medicaid contract amendments and program requirements across Aetna's 16 Medicaid managed care markets (and 26 distinct state contracts). Additionally, the incumbent will support the Lead Director in the ongoing maintenance and management of Medicaid compliance data and reporting in the CVS Health governance, risk, and compliance software platform (GRC tool) and the completion of the CVS Health enterprise risk assessment process for the Aetna Medicaid line of business. This position is responsible for promoting compliant and ethical behavior for Aetna's Medicaid business, including timely implementation of compliant business operations and new program requirements in accordance with Aetna's state Medicaid contracts. The incumbent will support complex market-specific implementations through coordinating activities across various health plan and business partners, researching contract and legislative guidance, and capturing compliance-specific documentation within the project team and designated tools. They will identify and escalate issues to help mitigate risk and resolve issues. Responsibilities include, but are not limited to: * Lead the compliance management and tracking activities regarding the implementation of complex Medicaid managed care contract amendments, new requirements, and various reports, including ad hoc activities * Review evidence of business compliance with new requirements to validate completion * Maintain documentation and data within the designated project management and tracking tools * Maintain knowledge of Aetna's Medicaid managed care state business practices and solutions to inform strategy, influence stakeholders, and/or inform projects. * Conduct research and develop recommendations to help develop compliant business operations, processes and policies in accordance with state specific Medicaid program requirements * Maintain positive, productive relationships with internal and external constituents through recurring and ad hoc touch points to effectively communicate and influence ethical and compliant outcomes, inform projects, provide status updates, and address issues * Review new mandates (laws and regulations) pertaining to Medicaid business practices. * Actively participate in applicable business working groups/committees for areas of responsibility. * Work across members of the Medicaid compliance team and growth partner business areas to develop and maintain the systems and tools to track, monitor, and report out on compliance related deliverables and projects * Manages moderately to highly complex cross functional and process improvement projects as needed on behalf of the Medicaid compliance team to improve oversight, monitoring, and identification of compliance risks and issues across the Medicaid business * Develop compelling and appropriate compliance related communications to internal growth partners, Medicaid health plan leadership, and Compliance leadership * Maintain an in-depth working knowledge of the contractual, regulatory, and program policy related obligations of a Medicaid managed care organization and serve as a resource to health plan and growth partner staff for education and business decision making purposes * Maintain current resource tools and other internal deliverables to support Medicaid compliance work across the portfolio of Aetna's Medicaid managed care plans such as executive risk assessments, risk tracking lists, internal reporting systems and summaries, and other department wide tools as needed to ensure the appropriate monitoring and oversight of health plan compliance processes * Utilize systems unique to job functions, including standard-issue software such as Microsoft products and compliance specific tools such as Archer; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenance * Provide training and guidance to less experienced team members to accomplish goals * Other duties as assigned In order to be successful in this role you must exhibit the following: * Strong interpersonal and communication skills, including the ability to interact and influence at various levels of the organization. * Ability to work independently and to recognize and resolve issues. * Experience in SharePoint and MS Teams *Required Qualifications* * 5+ years of Medicaid operations, compliance, or related job function in managed care, health care, or insurance (or comparable education/certifications) * 5+ years of project management experience * 5+ years in Microsoft applications (Word, Excel, PowerPoint) *Preferred Qualifications* * Experience with Medicaid or Medicaid managed care compliance * Knowledge of state Medicaid managed care contracts * Preferred experience participating in Medicaid managed care implementation projects * Experience development SharePoint sites and workflows * Expert level MS Excel skills * Experience with the development and maintenance of GRC tools *Education* * Bachelor's Degree, project management certification, OR directly related equivalent work experience required *Pay Range* The typical pay range for this role is: $75,400.00 - $174,200.00 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 [jobs.CVSHealth.com/benefits](https://jobs.cvshealth.com/benefits) We anticipate the application window for this opening will close on: 06/28/2024
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