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Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.Position SummaryExperienced/career level compliance position that supports the compliance program activities of Aetna’s Medicaid managed care business. In partnership with and under the direction of the Lead Director, National Medicaid Business Compliance Office (BCO) help develop and maintain systems and processes for the management, execution, and oversight of the implementation of new state Medicaid contract amendments and program requirements across Aetna’s 16 Medicaid managed care markets (and 26 distinct state contracts). Additionally, the incumbent will support the Lead Director in the ongoing maintenance and management of Medicaid compliance data and reporting in the CVS Health governance, risk, and compliance software platform (GRC tool) and the completion of the CVS Health enterprise risk assessment process for the Aetna Medicaid line of business.This position is responsible for promoting compliant and ethical behavior for Aetna’s Medicaid business, including timely implementation of compliant business operations and new program requirements in accordance with Aetna’s state Medicaid contracts. The incumbent will support market-specific implementations through coordinating activities across various health plan and business partners, researching contract and legislative guidance, and capturing compliance-specific documentation within the project team and designated tools. They will identify and escalate issues to help mitigate risk and resolve issues.Responsibilities include, but are not limited to:
Lead the compliance management and tracking activities regarding the implementation of Medicaid managed care contract amendments, new requirements, and various reports, including ad hoc activities
Review evidence of business compliance with new requirements to validate completion
Maintain documentation and data within the designated project management and tracking tools
Maintain knowledge of Aetna’s Medicaid managed care state business practices and solutions to inform strategy, influence stakeholders, and/or inform projects.
Conduct research and develop recommendations to help develop compliant business operations, processes and policies in accordance with state specific Medicaid program requirements
Maintain positive, productive relationships with internal and external constituents through recurring and ad hoc touch points to effectively communicate and influence ethical and compliant outcomes, inform projects, provide status updates, and address issues
Review new mandates (laws and regulations) pertaining to Medicaid business practices.
Actively participate in applicable business working groups/committees for areas of responsibility.
Identify and support ongoing Medicaid Compliance initiatives.
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
Provide training and guidance to less experienced team members to accomplish goals
Other duties as assigned
Required Qualifications
2+ years of Medicaid operations experience, OR 2+ years of experience in a comparable field
2+ years of project management experience (or comparable education/certifications)
5+ years in Microsoft applications (Word, Excel, PowerPoint)
Preferred Qualifications
Experience in SharePoint and MS Teams
Strong interpersonal and communication skills, including the ability to interact and influence at various levels of the organization.
Ability to work independently and to recognize and resolve issues
Experience in Medicaid managed care compliance
Knowledge of state Medicaid managed care contracts
Experience participating in Medicaid managed care implementation projects
Experience development SharePoint sites and workflows
Expert level MS Excel skills
Experience with the development and maintenance of GRC tools
Education
Bachelor’s Degree or equivalent experience
Pay RangeThe typical pay range for this role is:$43,700.00 - $107,200.00This 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, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.
