Director, Medicaid Regulatory Affairs

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable, and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family, and one community at a time. The Aetna Better Health of Maryland (ABHMD) Director of Medicaid Regulatory Affairs plays a key role on the ABHMD leadership team and the Maryland Department of Health (MDH). The Director serves as the ABHMD Government Liaison and works closely with the CEO, ABHMD Executive Leadership Team (ELT), and all shared service partners to sustain and grow ABHMD membership and ensure the program’s operating efficiency and financial strength. The Director is the senior leader responsible for ongoing program communications and coordination with MDH on behalf of ABHMD, and acts as a bridge between the health plan and government entities such as the Maryland Department of Health and Centers for Medicare & Medicaid Services, while focusing on internal execution, external strategic alignment, plan licensing, policy changes, and the MCO contract. Specific Duties Compliance & Policy: Interpret and implement complex Medicaid regulations and ensure the Aetna Better Health of Maryland adheres to them. Government Relations: Serve as the key liaison to state and federal regulators, managing filings, audits, and policy negotiations while supplying regulatory updates to plan leadership on all State and Federal rulemaking and contract communications. Risk Mitigation: Identify upcoming regulatory shifts and develop organizational strategies to adapt without service interruption. Strategic Planning: Translate the CEO's vision, State and Federal regulatory requirements into actionable, day-to-day goals for the Aetna Better Health of Maryland health plan departments. Cross-Functional Leadership: Coordinate initiatives across different departments (e.g., Clinical, Finance, Provider Relations, and Legal). Executive Operations: Under the direction of the CEO, manage high-priority projects and act as an advisor and gatekeeper for the Aetna Better Health of Maryland executive team. State Contract Implementation, Management and Oversight: Develop and manage project plans to implement State contract amendments, field, and coordinate responses to State inquiries and participate in state meetings, summarizing results and action items. New Initiatives and Vendor Approvals: Prepare all state filings on innovative programs/vendors for State submission and approval. Required Qualifications 7+ years in Medicaid managed care contracting, compliance, or regulatory affairs Knowledge of Maryland legislative, administrative, and regulatory processes Experience with relevant stakeholders including the Maryland Department of Health for Medicaid Services and the Maryland medical provider community Maryland Medicaid (HealthChoice) regulatory experience Strong analytical skills and diligence, including interpreting and executing regulatory and contractual language Effective communication skills, both written and verbal Strong political acumen with ability to effectively interact with State partners Excellent organization and time management skills Understanding of health plan operations, including contracting, claims processing, encounter data processing, and Medicaid eligibility and enrollment Experience navigating a matrixed organization Experience developing and executing project plans and processes Preferred Qualifications Hybrid work environment: If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. All hires for in-scope populations should be placed into a hybrid or office‑based location, working onsite three days a week. Aetna Service Operations office/hub locations will be discussed with the selected candidate. Education Bachelor’s degree or equivalent work experience The Typical Pay Range For This Role Is $100,000.00 – $231,540.00 This 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. This position also includes an award target in the company’s equity award program. Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr CVS Health