Senior Manager, Corporate Compliance – Special Needs Plans

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

📋 Description

• Act as the market compliance officer for designated Special Needs Plans (SNPs).

• Monitor, research, analyze, interpret, and communicate relevant CMS and state regulations along with government contract requirements to formulate recommendations, provide direction, and escalate issues, ensuring Aetna’s compliance with federal and state-specific program requirements and the CVS Code of Conduct.

• Lead and execute a robust Compliance Program as outlined in CMS Medicare Managed Care Manuals/regulations, pertinent Medicaid guidelines, and government contracts, including conducting risk assessments, auditing, monitoring, and overseeing corrective actions.

• Develop and oversee compliance strategies, programs, and processes that encourage ethical behavior, fulfill regulatory commitments, and prevent, detect, and mitigate compliance risks.

• Foster and sustain positive relationships with internal and external stakeholders at senior levels to facilitate decision-making and promote ethical and compliant results.

⛳️ Requirements

• Over 7 years of experience in compliance or regulatory work related to Medicare or Medicare Advantage government healthcare programs.

• More than 2 years of experience in Project Management.

• Willingness to travel up to 10% of the time.

• Comprehensive knowledge of Medicare and Medicaid compliance programs and regulations, including those specific to special needs plans, as well as CMS, NCQA, and state standards governing SNP Models of Care, Care Management, and Quality Improvement Programs.

• Experience in validation, auditing, monitoring, root cause analysis, and oversight of corrective actions.

• Exceptional time management and project management abilities.

• Proficient in the use of information systems.

• Expertise in analyzing complex regulatory rules and effectively communicating requirements to support business stakeholders.

• Strong problem-solving and decision-making skills.

🏝️ Benefits

• Medical, dental, and vision insurance.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources based on eligibility.