Senior Manager, Medicaid Compliance

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

📋 Description

• Serve as the designated Compliance Officer for Aetna’s Ohio Medicaid health plan.

• Manage, execute, and oversee the activities and deliverables of the compliance program.

• Supervise compliance team members assigned to the Ohio market.

• Act as the primary liaison to the state Medicaid agency.

• Track, monitor, review, and submit regulatory and compliance deliverables and responses.

• Prepare and oversee the development of complex regulatory reports and deliverables.

• Facilitate the preparation for and management of external audits, ensuring report and corrective action plan closure.

• Lead and execute all components of the Medicaid compliance program.

• Research and formulate recommendations for compliant business operations, processes, and policies.

• Develop compliance communications to address inquiries from the state Medicaid agency.

• Maintain compliance tools, contract libraries, reporting assignments, risk assessments, and tracking systems.

• Identify risks and conduct oversight and monitoring throughout the business.

• Support mitigation and corrective action plans, escalating risks and concerns as necessary.

• Utilize and maintain Microsoft and Archer systems, including documentation and system design or maintenance.

• Cultivate relationships with both internal and external senior-level stakeholders.

• Provide training and guidance to less experienced team members.

• Perform additional duties as assigned.

⛳️ Requirements

• A minimum of 7 years of regulatory compliance experience in managed care, health care, or insurance.

• At least 2 years of project management experience.

• Bachelor’s Degree in Public Policy, Government Affairs, Health Care Administration, or Public Administration is preferred; or equivalent years of relevant professional work experience.

• Experience with Medicaid or Medicaid managed care is preferred.

• Audit experience is a plus.

• Proficiency in Microsoft products.

• Familiarity with Archer or similar compliance-specific tools.

• Capability to serve as the designated Compliance Officer for Aetna’s Ohio Medicaid health plan.

• Ability to manage, execute, and oversee Medicaid compliance program activities and deliverables effectively.

• Knowledge of contractual, regulatory, and program policy obligations is essential.

• Ability to train and mentor less experienced team members.

🏝️ Benefits

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

• Award target 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.