Senior Manager Corporate Compliance (Medicare Duals)

• Serve as plan compliance officer for assigned Medicare-Medicaid and/or SNP plan

• 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 regulations and contracts in support of 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.

• Other duties as assigned.In order to be successful in this role you must exhibit the following: --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 teamworkRequired Qualifications

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

Education
Bachelor's Degree required or equivalent years of related experience.Pay Range

The typical pay range for this role is:$75,400.00 - $165,954.00

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.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 peopleWe 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:

• 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 07/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.