Medicaid Compliance Leader

CVS Health; Phoenix (AZ); On-site; USD 60,000 - 133,000; Full time

Benefits offered by this job

Bonus eligibility

Job summary

CVS Health is seeking a Medicaid Compliance Manager to join our compliance program for Arizona Medicaid plans. You will support the development and maintenance of processes that demonstrate an effective compliance program and promote ethical behavior in our Medicaid health plans.

You will lead tracking of regulatory deliverables, coordinate audits, and advise on policies to ensure adherence to Arizona Medicaid requirements. A strong PM background and experience in managed care are required.

Qualifications

• Minimum 5 years in regulatory compliance in managed care, health care, or insurance.
• Project management experience required.

Responsibilities

• Maintain systems to track, monitor, and submit regulatory and compliance deliverables to Arizona Medicaid agencies by due dates.
• Develop compliant business operations, processes, and policies per Arizona Medicaid requirements.
• Create compliance communications responding to Arizona Medicaid inquiries for Mercy Care.
• Maintain knowledge of Mercy Care obligations as a Medicaid managed care org; advise staff accordingly.
• Manage external audit reviews with subject matter experts, tracking deliverables and corrective actions.
• Maintain tools, contracts, risk assessments, and internal reporting systems for compliance oversight.
• Utilize systems like Archer; train users and contribute to systems design/maintenance.
• Monitor compliance across the business; help partners mitigate risks and escalate issues.

Skills

Project management

Regulatory compliance

Stakeholder collaboration

Communication

Education

Bachelor’s Degree

Master’s degree preferred

Tools

Archer

Job description

CVS Health is seeking a Medicaid Compliance Manager to join our compliance program for Arizona Medicaid plans. You will support the development and maintenance of processes that demonstrate an effective compliance program and promote ethical behavior in our Medicaid health plans.

You will lead tracking of regulatory deliverables, coordinate audits, and advise on policies to ensure adherence to Arizona Medicaid requirements. A strong PM background and experience in managed care are required.