Senior Manager, Corporate Compliance – Special Needs Plans

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Job Description:

  • Serve as market compliance officer for assigned Special Needs Plans (SNPs)
  • Track, analyze, research, interpret, communicate and monitor applicable CMS and state regulations and government contract requirements to develop recommendations, direction, and escalation ensuring Aetna’s that implementation and integration of program requirements complies with federal and state specific program requirements and the CVS Code of Conduct
  • Lead and implement an effective Compliance Program as described in CMS Medicare Managed Care Manuals/regulations, applicable Medicaid rules and government contracts, including risk assessment, auditing and monitoring and corrective action oversight
  • Develop and manage compliance strategies, programs, and processes that promote compliant and ethical behavior, meet regulatory obligations, and prevent, detect, and mitigate compliance risks
  • Build and maintain positive relationships with internal and external constituents at senior levels to drive decision-making and influence ethical and compliant outcomes

Requirements:

  • 7+ years experience in Medicare or Medicare Advantage government healthcare program compliance or regulatory work
  • 2+ years of Project Management experience
  • Ability to travel up to 10%
  • Extensive knowledge of Medicare and Medicaid compliance programs and rules, including rules applying to special needs plans and CMS, NCQA and state rules and standards governing SNP Models of Care, Care Management and Quality Improvement Programs
  • Experience in validation, auditing and monitoring, root cause analysis and corrective action oversight
  • Outstanding time management and project management
  • Proficient in utilization of information systems
  • Mastery in complex regulatory rule analysis and clear communication of requirements to support business stakeholders
  • Mastery of problem solving and decision making skills

Benefits:

  • medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs
  • other resources, based on eligibility
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