Senior Manager – Business Compliance

This is a fully remote position, open to applicants in Alabama, +43 more states.

📋 Description

• Oversee and analyze new and changing regulatory requirements and standards.

• Act as a liaison with CMS representatives, external contractors, legal advisors, and internal teams.

• Create and uphold compliance oversight protocols.

• Identify operational and compliance deficiencies and establish mitigation plans.

• Work alongside business leaders to ensure policies and workflows are compliant.

• Collaborate with Quality and Audit teams for CMS responses and various audits, including internal, NCQA, departmental, and mock audits.

• Utilize compliance reporting tools to monitor performance, identify trends, and escalate risks to executive leadership and business partners.

• Develop and oversee a long-term operational strategy for appeals and audit responses.

• Establish and lead cross-functional teams aimed at addressing compliance risks and regulatory requirements.

• Continuously monitor compliance, perform risk assessments, and assist with audits.

• Plan and implement projects related to compliance and regulatory requirements.

⛳️ Requirements

• At least 7 years of Medicare experience relevant to the specified duties and responsibilities, or an equivalent combination of education and work experience.

• Minimum of 7 years of experience in CMS audits, Medicare compliance, or service operations.

• Capacity to comprehend complex issues and collaborate with business leaders to devise, resolve, and implement solutions.

• Experience working directly with CMS or other regulatory authorities.

• Associate’s degree or equivalent professional experience.

• Clinical licensure (RN) is preferred.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Opportunity for award targets in the company’s equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.