Senior Manager, Medicare Business Compliance

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. At Aetna®, part of CVS Health, we proudly serve more than 26 million medical members through our broad range of health plan offerings. We're committed to delivering a simpler, more meaningful, and personal health care experience to each of them. As a Senior Manager Business Compliance (Medicare) you will play a critical role by leading and delivering complex compliance initiatives that support regulatory adherence and operational excellence. This role partners closely with cross‑functional business areas to plan, coordinate, and execute projects that mitigate operational and regulatory risk, with a strong emphasis on Medicare compliance. This position is a senior‑level project management position within Operations Integrity and offers broad exposure to internal business partners and leadership teams and provides the opportunity to demonstrate leadership, strategic thinking, and enterprise‑level influence. In this role, you will: Oversee the implementation and ongoing interpretation of Medicare laws, regulations, and regulatory guidance, ensuring timely and accurate execution across impacted business areas. Serve as a subject matter resource for inquiries and lead responses to audit and data requests from regulators, auditors, and internal oversight partners. Interpret regulatory guidance, assess compliance gaps, identify root causes, and design and implement sustainable corrective action plans. Routinely communicate project status, risks, and outcomes to senior leaders and executive stakeholders, translating complex regulatory requirements into clear, actionable business guidance. Oversight of new and updated regulatory guidance implementation, leadership of Annual Enrollment Period (AEP) readiness activities across multiple business areas, proactive identification and mitigation of operational risks, and end‑to‑end coordination of audit and regulatory responses. Contributes to regulatory compliance, operational stability, and overall member satisfaction. Required Qualifications Project Management : 5+ years of experience leading complex initiatives from planning through execution and delivery. Systems Expertise : Hands‑on experience with QuickBase. Communication Skills : Demonstrated strong oral and written communication skills. Executive Communication : Proven ability to communicate effectively with leaders at all levels, including executive leadership. Problem Solving & Decision Making : Strong analytical skills with the ability to assess issues, evaluate options, and make sound decisions. Collaboration & Teamwork : Adept at working collaboratively across cross‑functional teams to achieve shared goals. Growth Mindset : Demonstrated agility and commitment to continuous learning, development, and coaching of others. Execution & Delivery : Strong capability in planning, delivering, and supporting initiatives to achieve intended outcomes. Regulatory Expertise : Strong knowledge of Medicare regulations and regulatory guidance. Preferred Qualifications 5+ years Medicare operational experience Aetna systems experience Regulatory compliance experience We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the 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 Pay Range The typical pay range for this role is: $82,940.00 - $182,549.00. 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 for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. 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