Lead Director – Corporate Compliance

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Act as the appointed Compliance Officer for Aetna's IL Medicaid health plan.

• Serve as the main point of contact for the state Medicaid agency, facilitating compliance and contract-related communications and activities.

• Manage the preparation for and oversight of external audits conducted by state Medicaid and associated agencies or partners.

• Lead and implement all aspects of the Medicaid compliance program for Aetna’s IL Medicaid health plan.

• Conduct research and formulate recommendations to develop compliant business operations, processes, and policies in line with state-specific Medicaid program requirements.

• Create strategic and effective compliance-related communications on behalf of the health plan in response to inquiries or requests from the state Medicaid agency.

• Maintain a comprehensive understanding of the health plan’s contractual, regulatory, and program policy obligations as a Medicaid managed care organization, serving as a resource for health plan and growth partner staff for education, training, and business decision-making purposes.

• Ensure that current resource tools and other internal deliverables, such as the current contract library, regulatory reporting assignments, risk assessments, risk tracking lists, internal reporting systems and summaries, and other department-wide tools, are up-to-date and accessible to business partners to facilitate appropriate monitoring and oversight of health plan compliance processes.

• Utilize job-specific systems, including standard software like Microsoft products and compliance-specific tools such as Archer; maintain system documentation, act as a subject matter expert, train system users, and contribute to system design, oversight, or maintenance.

• Direct oversight and monitoring activities to assess compliance levels with new and existing Medicaid managed care organization requirements across the business; assist business partners in developing mitigation and corrective action plans and effectively escalate risks, concerns, and other issues through the appropriate channels.

• Foster positive and productive relationships with internal and external senior-level stakeholders to effectively communicate and influence ethical and compliant outcomes.

• Oversee the submission of required regulatory reports (both standard and ad hoc), including conducting high-level quality reviews prior to submission and maintaining tracking systems and tools to document ownership, reporting requirements, and monitor timely delivery and acceptance of reports.

• Provide training and mentorship to less experienced team members to help achieve objectives.

• Perform other duties as assigned.

⛳️ Requirements

• Over 10 years of prior experience in Medicaid or Medicaid managed care.

• More than 5 years in roles requiring project management skills and responsibilities.

• At least 2 years of previous management experience.

• Experience in auditing.

• A Master’s degree in Public Policy, Health Care Administration, Public Administration, or similar fields, or a law degree.

• A Bachelor's degree is required or equivalent years of related experience.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources.