Manager, Medicaid Compliance

Overview

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

As a Medicaid Compliance Manager, you will support the Mercy Care and Medicaid compliance program activities and deliverables. In partnership with and under the direction of the Mercy Care Compliance Officer, you will help develop and maintain systems and processes that demonstrate the principles of an effective Compliance program and promote compliant and ethical behavior within Mercy Care.

• Maintain the systems and tools to track, monitor, review, and submit required regulatory and compliance related deliverables and responses to Arizona Medicaid agencies on or before required due dates; prepares moderately complex regulatory reports as needed on behalf of the Medicaid compliance team

• Conduct research and develop recommendations to help develop compliant business operations, processes and policies in accordance with Arizona specific Medicaid program requirements

• Develop compelling and appropriate compliance related communications on behalf of Mercy Care in response to Arizona Medicaid agency inquiries or requests

• Maintain an in-depth working knowledge of the Mercy Care’s contractual, regulatory, and program policy related obligations as a Medicaid managed care organization and serve as a resource to Mercy Care and Medicaid growth partner staff for education and business decision making purposes

• Manage and support the external audit review process in conjunction with designated subject matter experts at Mercy Care, including, but not limited to the project management and tracking of required deliverables, responses, and corrective action plan development (through closure)

• Maintain current resource tools and other internal deliverables such as current contract library, regulatory reporting assignments, 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 Mercy Care and Medicaid 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 Mercy Care requirements across the business; support business partners in the development of mitigation and corrective action plans and effectively escalate risks, concerns and other issues through appropriate channels

• Maintain positive, productive relationships with internal and external constituents to effectively communicate and influence ethical and compliant outcomes

• Provide training and guidance to less experienced team members to accomplish goals

• Other duties as assigned

• Minimum of 5 years of regulatory compliance position in managed care, health care, or insurance

• Project management experience

Experience with Medicaid or Medicaid managed care

• Bachelor’s degree in Public Policy, Government Affairs, Healthcare Administration, Public Administration, or a related field; equivalent work experience may substitute

• Advanced degree (Masters degree or Juris Doctor) is a plus

40

Full time

The typical pay range for this role is:

$60,300.00 - $

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,…