Medicaid Compliance Manager — Audit & Policy Lead

9025 CVS Shared Services Resources LLC; Oklahoma City (OK); On-site; USD 54,000 - 119,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health in Oklahoma City is seeking an experienced compliance professional to support Medicaid managed care compliance programs, including regulatory tracking, reporting, and audit coordination.

The role requires 5+ years in regulatory compliance, project management, and knowledge of Medicaid requirements with a focus on conducting research, developing compliant operations, and guiding teams. Full-time role with comprehensive benefits and ongoing training.

Qualifications

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

Responsibilities

• Maintain the systems and tools to track, monitor, review, and submit required regulatory and compliance related deliverables to Oklahoma Medicaid agencies on or before 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 state specific Medicaid program requirements
• Develop compelling and appropriate compliance related communications on behalf of the health plan in response to Oklahoma Medicaid agency inquiries or requests
• Maintain an in-depth working knowledge of the health plan’s contractual, regulatory, and program policy related obligations as a Medicaid managed care organization and serve as a resource to health plan and 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 the health plan, 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 health plan 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 Medicaid managed care organization requirements across the business; support business partners in the development of mitigation and corrective action plans and effectively escalade 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

Skills

Regulatory compliance

Project management

Communication

Education

Bachelor’s Degree in Public Policy or related field

Tools

Archer

Microsoft Office

Job description

CVS Health in Oklahoma City is seeking an experienced compliance professional to support Medicaid managed care compliance programs, including regulatory tracking, reporting, and audit coordination.

The role requires 5+ years in regulatory compliance, project management, and knowledge of Medicaid requirements with a focus on conducting research, developing compliant operations, and guiding teams. Full-time role with comprehensive benefits and ongoing training.