Senior Manager, Corporate Compliance

Position Summary The Sr. Manager is an experienced/career level compliance position that applies compliance, regulatory, business, analytical and communication skills to support, manage and develop and execute Medicare and Medicaid compliance programs and processes that promote compliant and ethical behavior, meet regulatory obligations, and prevent, detect and mitigate compliance risks. Responsibilities Serve as market compliance officer for assigned Special Needs Plans (SNPs). Track, analyze, research, interpret, communicate and monitor applicable CMS and state regulations and government contract requirements to develop recommendations, direction, and escalation ensuring implementation and integration of program requirements complies with federal and state specific program requirements and the CVS Code of Conduct. Lead and implement an effective compliance program as described by CMS Medicare Managed Care Manuals/regulations, applicable Medicaid rules and government contracts, including risk assessment, auditing, monitoring, and corrective action oversight. Develop and manage compliance strategies, programs and processes that promote compliant and ethical behavior, meet regulatory obligations, and prevent, detect, and mitigate compliance risks. Maintain in-depth working knowledge and expertise in Medicare, Medicaid and state requirements, regulations and contracts with a focus on supporting special needs plans. Support and/or facilitate multiple compliance and contract related communications, activities and interactions with regulators, including meetings with regulators on compliance with laws and regulations, and developing strategic written responses to compliance-related regulatory inquiries. Lead and/or support numerous external regulatory review and audit activities, including preparation for and management of external audits conducted by CMS, state Medicaid and related agencies, and partners, through final report and corrective action plan closure. Build and maintain positive relationships with internal and external constituents at senior levels to drive decision-making and influence ethical and compliant outcomes. Monitor and audit as outlined in the Medicare Compliance Work Plan and direct other projects as assigned to evaluate compliance, propose remediation where necessary, and monitor implementation of corrective action. Utilize and maintain current information in systems unique to job functions, such as Microsoft products and compliance-specific tools such as Archer. Lead and support broader compliance initiatives and needs as assigned to ensure that effective compliance programs are achieved and maintained. Other duties as assigned. Qualifications Extensive knowledge of Medicare and Medicaid compliance programs and rules, including rules applying to special needs plans. Experience in validation, auditing and monitoring, root cause analysis, and corrective action oversight. Outstanding time management and project management skills. Proficiency in utilization of information systems. Mastery in complex regulatory rule analysis and clear communication of requirements to support business stakeholders. Mastery of problem solving and decision-making skills. Adept at execution and delivery (planning, delivering, and supporting). Adept at collaboration and teamwork in matrixed environments. Required Qualifications 7+ years experience in Medicare or Medicare Advantage government healthcare program compliance or regulatory work. 2+ years of Project Management experience. Ability to travel up to 10%. Preferred Qualifications Extensive knowledge of Medicare and Medicaid compliance programs and rules, including rules applying to integrated duals plans and other special needs plans. Education Bachelor's Degree required; equivalent work experience may substitute. Pay Range The typical pay range for this role is: $75,400.00 - $165,954.00. This range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. Benefits Medical, dental, and vision coverage. Paid time off. Retirement savings options. Wellness programs. 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 9025 CVS Shared Services Resources LLC