Medicaid Compliance Specialist — Managed Care

CVS Health; Honolulu (HI); Sur place; USD 44 000 - 102 000; Plein temps

Avantages offerts par ce poste

Comprehensive benefits package

Bonus eligibility

Paid time off

Résumé du poste

CVS Health is seeking a Career level compliance professional to support our Medicaid managed care compliance program. You will help develop and maintain systems and processes that promote an effective compliance program and ethical behavior across plans.

Responsibilities include tracking deliverables, researching compliant operations, and developing communications for Medicaid inquiries. You will work with the Compliance Officer and senior team members to ensure monitoring and education across

Qualifications

• Minimum 2+ years of regulatory compliance experience in managed care, healthcare, or insurance.
• Experience with Medicaid or Medicaid managed care is preferred.
• Project management experience is preferred.
• Audit experience is preferred.

Responsabilités

• Maintain systems and tools to track regulatory deliverables and respond to Medicaid agencies by deadlines.
• Support research and recommendations to develop compliant business operations per state Medicaid requirements.
• Develop compliant communications in response to Medicaid agency inquiries.
• Maintain knowledge of contractual, regulatory, and program obligations for Medicaid managed care.
• Support external audit reviews, including project management and corrective action tracking until closure.
• Maintain internal tools and reporting systems to ensure monitoring of compliance processes.
• Train users on system tools and contribute to system design and maintenance.
• Foster positive relationships with internal and external stakeholders to promote ethical, compliant outcomes.

Connaissances

Regulatory compliance

Healthcare compliance

Medicaid knowledge

Formation

Bachelor’s Degree

Description du poste

CVS Health is seeking a Career level compliance professional to support our Medicaid managed care compliance program. You will help develop and maintain systems and processes that promote an effective compliance program and ethical behavior across plans.

Responsibilities include tracking deliverables, researching compliant operations, and developing communications for Medicaid inquiries. You will work with the Compliance Officer and senior team members to ensure monitoring and education across