Manager, Business 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. Candidate must reside in the EST or CST Position summary

Manger level position that applies expertise in compliance, legal and communication skills to support manage and develop compliant strategies. Responsibilities include monitoring, investigating training/education enforcement, reporting, collaborating and consulting with business leaders, engaging with key stakeholders on compliance related issues to meet regulatory and legal obligations to prevent, detect, and mitigate compliance risks.Functional

• Supports the implementation and maintenance of an effective Compliance program supporting First Health, Aetna Signature Administrators, and American Health Holding, including, but not limited to risk assessments, auditing and monitoring, maintaining effective compliance policies and procedures, as well as developing effective communications and trainings when needed.
• Prepares regulatory reports, regulatory filings and follow up activity as needed, and manages regulatory complaint review and audit activities.
• Independently manages multiple complex regulatory interactions, including drafting regulatory correspondence, responding to regulatory inquiries, and negotiating resolution of regulatory matters, requiring a sophisticated understanding of business processes and regulatory requirements.
• Leads complex compliance business process reviews, corrective actions, and other projects involving internal and external constituents.
• Independently develops strategy, processes, forms and related materials to meet complex regulatory and legal requirements.
• Builds and maintains positive, productive relationships with internal and external constituents at the varying leadership levels, and can remove significant barriers, drive decision-making, and influence ethical and compliant outcomes at all levels necessary to accomplish goals.
• Independently identifies and assesses the complex compliance issues and risks, engages appropriate enterprise resources, supports internal and external constituents in the development and monitoring of effective corrective action and risk mitigation plans, and supports related activities and communications.
• Responds to complex requests for information within one's area of responsibility from internal and external constituents
• Acts as a resource and subject matter expert for colleagues and effectively guides business partners and teams to accomplish complex goals.

• 5+ years' experience in a regulatory compliance position in healthcare.
• Demonstrated working knowledge of federal laws concerning healthcare and health insurance law, including federal healthcare reform, HIPAA, ERISA, No Surprise Act, and federal and state Mental Health Parity laws
• Demonstrated working knowledge of state insurance laws and the relationship between state and federal laws.
• Ability to quickly develop an understanding of Aetna's Commercial and Wholesale business products and services
• Ability to organize and lead important meetings with varying levels of leadership, and report out critical information and important updates as needed
• Excellent written and verbal communication skills
• Adept at problem solving and decision-making skills
• Excellent collaboration skills and can thrive in a team setting

• Familiarity with provider directory requirements and laws
• Experience with clinical operations - utilization management, case management, disease management.
• Experience with URAC and NCQA accreditation requirements
• Experience collaborating with legal counsel to help advise internal and external customers

• Bachelor's degree preferred or a combination of professional work experience and education.

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.