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Sr Mgr, Medicaid Compliance (National)



Tampa, FL, USA
Posted on Tuesday, June 11, 2024

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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 per week and two days remote***

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 Chief Medicaid Compliance Officer and Medicaid Compliance leadership team, this position will help develop and maintain systems and processes for the development and management of internal corrective actions plans (iCAPs) at a national level across Aetna’s Medicaid business. Additionally, the incumbent will lead and participate in other key department projects and initiatives to improve and enhance Aetna’s Medicaid Compliance program, and serve as the compliance representative on national workgroups as necessary.

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 have a broad understanding of Aetna’s Medicaid contracts (currently 26 distinct contracts) and develop strong working relationships across the health plan and Share Services business partners. They will identify and escalate issues to help mitigate risk and resolve issues.

Responsibilities include, but are not limited to:

  • Initiate and manage the development and execution of national-level internal corrective action plans (iCAP) for Aetna’s Medicaid business
  • Track the ongoing activities and progress against iCAP milestones and deadlines
  • Maintain documentation and data within Aetna’s designated governance, risk, and compliance (GRC) tool (Archer)
  • Review evidence of remediation completion prior to iCAP closure
  • Assist in the review and update of Archer documentation of iCAPs and external CAPs across all markets to facilitate internal reporting to Medicaid leadership
  • 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
  • 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
  • Conduct oversight and monitoring to evaluate levels of compliance with Medicaid managed care organization requirements across the business with a particular focus on risks and issues impacting multiple Medicaid markets; support business partners in the development of mitigation and corrective action plans and effectively escalate risks, concerns and other issues through appropriate channels
  • Provide training and guidance to less experienced team members to accomplish goals
  • Other duties as assigned

Required Qualifications

  • 7+ years regulatory compliance position in managed care, health care, or insurance or higher education with 5+ years of experience
  • 3+ years of Medicaid experience
  • 3+ years of project management experience

Preferred Qualifications

  • Bachelor’s degree preferably in Public Policy, Government Affairs, Health Care Administration, or Public Administration
  • Masters degree or Juris Doctor
  • Direct experience in Medicaid managed care compliance


  • Bachelor’s Degree or equivalent experience

Pay Range

The typical pay range for this role is:

$67,900.00 – $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

We anticipate the application window for this opening will close on: 08/31/2024