Category: Curator- Job Hunter

 
 

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

Improving Members’ experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

 
 

Clipped from: https://jobs.communityhealthchoice.org/hedis-and-risk-adjustment-specialist-154356/job/15847356?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

 
 

 
 

Summary

This position is located in the Department of Health & Human Services, Centers for Medicare & Medicaid Services, Center for Consumer Information and Insurance Oversight (CCIIO), Consumer Support Group (CSG).As a Supervisory Health Insurance Specialist, GS-0107-14, you will responsible for leading, coordinating and developing program, policy in the area of Marketplace enrollment assistance, Marketplace Navigators, budget, procurement, staff and administrative functions for the DAP. Learn more about this agency

Responsibilities

Provides strategic, long-range business planning for the implementation and operations of Marketplace in-person enrollment assistance, including the Navigator program. Performs gap analysis and develops cross-component business plans to assure all Affordable Care Act (ACA)-related requirements are addressed and in production in accordance with key implementation project deadlines. Assists in directing issues such as budget formulation, procurements, and other high profile issues in the area of ACA-related programs. Provides leadership and direction for constructive communication and effective collaboration with our partners, such as the health care industry, other government entities, and consumer advocacy groups. Assigns work to subordinates based on priorities; selective consideration of the difficulty and requirements of assignments, and the capabilities of employees.

Travel Required Occasional travel

• You may be expected to travel 10% for this position.Supervisory status
  
  
  Yes Promotion Potential
  
  
  14
  
  
  Job family (Series)
  
  
  0107 Health Insurance Administration
  
  
  Help Requirements Conditions of Employment
  
  
  You must be a U.S. Citizen or National to apply for this position. You will be subject to a background and suitability investigation. Time-in-Grade restrictions apply.
  
  
  Qualifications
  
  
  ALL QUALIFICATION REQUIREMENTS MUST BE MET WITHIN 30 DAYS OF THE CLOSING DATE OF THIS ANNOUNCEMENT.Your resume must include detailed information as it relates to the responsibilities and specialized experience for this position. Evidence of copying and pasting directly from the vacancy announcement without clearly documenting supplemental information to describe your experience will result in an ineligible rating. This will prevent you from receiving further consideration.In order to qualify for the GS-14, you must meet the following: You must demonstrate in your resume at least one year (52 weeks) of qualifying specialized experience equivalent to the GS-13 grade level in the Federal government, obtained in either the private or public sector, to include:1) Developing implementation plans for Marketplace in-person enrollment assistance programs(i.e., Navigator and Certified Application Counselor programs);2) Overseeing Marketplace in-person enrollment assistance program policy and operations;3) Overseeing the work of subordinate employees or team members; and4) Providing oversight of contractors that support Marketplace in-person enrollment assistance programs, including the Navigators and Certified Application Counselor programs..Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.Time-in-Grade: To be eligible, current or former Federal employees and current or former Federal employees applying under the VEOA eligibility who hold or have held a permanent General Schedule position in the previous year must have served at least 52 weeks (one year) at the next lower grade level from the position/grade level(s) to which they are applying.Click the following link to view the occupational questionnaire: https://apply.usastaffing.gov/ViewQuestionnaire/11099796 Education
  
  
  This job does not have an education qualification requirement. Additional informationBargaining Unit Position: NoTour of Duty: FlexibleRecruitment/Relocation Incentive: Not AuthorizedFinancial Disclosure: Not RequiredFull-Time Telework Program for CMS Employees: CMS employees currently participating in 100% Full-Time Telework Program may be eligible to remain in the program. If an employee in this program is selected, the pay will be set in accordance with the locality pay for the applicable duty station. The listed salary range reflects the locality pay assigned to the duty location(s) listed in the vacancy announcement. For more information about pay based on locality, please visit the Office of Personnel Management (OPM) Salaries & Wages Page.Additional Forms REQUIRED Prior to Appointment:Optional Form 306, Declaration of Federal Employment and the Background/Suitability Investigation
• A background and suitability investigation will be required for all selectees. Appointment will be subject to the successful completion of the investigation and favorable adjudication. Failure to successfully meet these requirements may be grounds for appropriate personnel action. In addition, if hired, a reinvestigation or supplemental investigation may be required at a later time. If selected, the Optional Form 306 will be required prior to final job offer. Click here to obtain a copy of the Optional Form 30
• Form I-9, Employment Verification and the Electronic Eligibility Verification Program
• CMS participates in the Electronic Employment Eligibility Verification Program (E-Verify). E-Verify helps employers determine employment eligibility of new hires and the validity of their Social Security numbers. If selected, the Form I-9 will be required at the time of in-processing. Click here for more information about E-Verify and to obtain a copy of the Form I-
• Standard Form 61, Appointment Affidavits
• If selected, the Standard Form 61 will be required at the time of in-processing. Click here to obtain a copy of the Standard Form
• The Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) provide eligible displaced federal employees with selection priority over other candidates for competitive service vacancies. To be qualified you must submit the required documentation and be rated well-qualified for this vacancy. Click here for a detailed description of the required supporting documents. A well-qualified applicant is one whose knowledge, skills and abilities clearly exceed the minimum qualification requirements of the position. Additional information about ICTAP and CTAP eligibility is on OPM’s Career Transition Resources website at www.opm.gov/rif/employee_guides/career_transition.asp.If you are unable to apply online or need to fax a document you do not have in electronic form, view the following link for information regarding an Alternate Application.
  
  
  Read more
  
  
  How You Will Be EvaluatedYou will be evaluated for this job based on how well you meet the qualifications above.
  
  
  Additional selections may be made for similar positions across the Department of Health and Human Services (HHS) within the local commuting area(s) of the location identified in this announcement. By applying, you agree to have your application shared with any interested selecting official(s) at HHS. Clearance of CTAP/ICTAP will be applied for similar positions across HHS.Once the announcement has closed, your online application, resume, transcripts and CMS required documents will be used to determine if you meet eligibility and qualification requirements listed on this announcement. If you are found to be among the top qualified candidates, you will be referred to the selecting official for employment consideration. Please follow all instructions carefully. Errors or omissions may affect your rating.Your qualifications will be evaluated on the following competencies (knowledge, skills, abilities and other characteristics):Building Coalitions/CommunicationsBusiness AcumenLeading PeopleManaging ChangeResults DrivenRead more
  
  
  Background checks and security clearanceSecurity clearance
  
  
  Not Required Drug test required
  
  
  No Position sensitivity and risk
  
  
  Moderate Risk (MR) Trust determination process
  
  
  Credentialing, Suitability/Fitness
  
  
  Help Required DocumentsThe following documents are REQUIRED:
• Resume showing relevant experience; cover letter optional. Your resume must indicate your citizenship and if you are registered for Selective Service if you are a male born after 12/31/
• Your resume must also list your work experience and education (if applicable) including the start and end dates (mm/yyyy) of each employment along with the number of hours worked per week. For work in the Federal service, you must include the series and grade level for the position(s). Your resume will be used to validate your responses to the assessment tool(s). For resume and application tips visit: https://www.usajobs.gov/Help/faq/application/documents/resume/what-to-include/
• CMS Required Documents (e.g., SF-50, DD-214, SF-15, etc.). Required documents may be necessary to be considered for this vacancy announcement. Click here for a detailed description of the required documents. Failure to provide the required documentation WILL result in an ineligible rating OR non-consideration.PLEASE NOTE: A complete application package includes the online application, resume, transcripts and CMS required documents. Please carefully review the full job announcement to include the “Required Documents” and “How to Apply” sections. Failure to submit the online application, resume, transcripts and CMS required documents, will result in you not being considered for employment.
  
  
  Help BenefitsA career with the U.S. Government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits. Review our benefits Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time, or intermittent. Contact the hiring agency for more information on the specific benefits offered.

Clipped from: https://www.linkedin.com/jobs/view/supervisory-health-insurance-specialist-at-centers-for-medicare-medicaid-services-2534538824/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Aetna

Job Description

Job DescriptionThis is an senior level actuarial analyst position which supports pricing, reserving, and experience analysis for Medicaid markets. You will support actuarial functions by applying quantitative skills and analytical methods to well defined projects. Set own priorities within pre-established overall deadlines. Use strong technical skills in a functional manner and demonstrate fundamental business and product knowledge. Generate own work product ideas and get buy-in from business partners.Required Qualifications-Bachelor’s degree with concentration typically in Actuarial Science, Mathematics, Finance, Statistics, Economics or related field.-Must have passed a minimum of 1+ actuarial exam(s) and interested in pursuing your actuarial designation.-2-4 years actuarial experiencePreferred Qualifications-Strong technical skills in Excel, SQL or SAS are highly desired. -Strong communication skills.Education-Bachelor’s degree or equivalent experience.Business OverviewAt Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

 
 

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State of MontanaHelena, MT Full-time

• Below are more detailed job duties: Develops and manages the quality measures for Medicaid Waiver Program using extensive knowledge of federal and state program policies, mandates, directives and intents; department and division goals; as well as data and information systems, statistics, and public relations.
• Develops provider notices, provider manuals, and desk level procedures associated with the administration of Medicaid waiver.
• Agency: Department of Public Health & Human Services Union: 000 – None Bargaining Unit: 000 – None
• Minimum Qualifications: Bachelor’s Degree in human services, business/public/health administration, or related fields.
• Manages the waiver program incident reporting for persons with severe disabling mental illness to ensure health, wellness, and safety requirements are compliant with federal and state regulations.
• The Addictive and Mental Disorders Division (AMDD) administers program and payment for publicly funded behavioral health services, which include adult mental health and adult and youth substance use disorder (SUD) prevention and treatment programs.
• Experience with the Montana Medicaid Information System (MMIS) is preferred.
• Services range from prevention and early intervention services to inpatient, residential, home- and community-based, and recovery support services.

 
 

Clipped from: https://jobsearcher.com/j/medicaid-waiver-state-plan-program-manager-at-state-of-montana-in-helena-mt-AAP77Jp?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

 
 

Description

SHIFT: Day Job

SCHEDULE: Full-time

 

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health benefits companies and a Fortune Top 50 Company.

Title: Staff VP Encounters

Location: Virginia Beach, VA or within commutable distance to a local office

Travel: 25%

Responsible for the strategic, design and management of the Encounters e2e program and team that supports the day to day Encounter intake, analysis and submissions to federal and state partners, as well as the implementation of company-wide initiatives

Primary duties may include, but are not limited to:

• Oversees Encounters performance metrics ensuring timeliness, accuracy and completeness are met with state and federal partners for all lines of business
• Oversees Encounters submissions, rejection management & resolution for all lines of business including internal strategic partnerships supporting the production of encounters as well as providing overall organizational leadership aimed at managing overall healthcare costs
• Ongoing monitoring and management resolution for any potential penalties related to performance measurements of encounters submissions
• Engages with internal business partners and IT to analyze the root cause, identify potential risks, find ways to improve upon performance and lead the needed changes
• Develops and leads strategic innovative initiatives to deliver more value for state and federal partners. Consults and calibrates with senior leaders as well as vendors and outside organizations, being the face of Encounters for the Anthem enterprise
• Identifies, develops, hires, trains, coaches, counsels, and evaluates performance of direct reports

Qualifications

• Requires a BA/BS in business or related field; 15+ years of experience in Healthcare or Operations industry;
• Advanced strategic planning, organizational, managerial, and leadership skills; excellent verbal and written communication skills, experience drafting proposal, obtaining consensus for approving and implementing future state processes and systems need to support strategic direction or any combination of education and experience, which would provide an equivalent background.
• 5+ Medicare and Government Medicare, Medicaid
• 5+ Claims payment processing
• 5+ Financial management
• 5+ Regulatory and/or government experience

Preferred requirements:

• MA/MBA
• Vendor Management experience
• Claims and Encounters within Health Insurance
• Six Sigma, Agile Methodology and Design Thinking
  
  
  
  We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs, and financial education resources, to name a few.
  
  
  Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

 
 

 
 

Clipped from: https://anthemcareers.ttcportals.com/jobs/6579403-staff-vp-encounters-gbd-medicare-and-medicaid?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Anthem, Inc.

Job Description

Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America’s leading health benefits companies and a Fortune Top 50 Company. Given Anthem’s scale, balance sheet, broad national reach and depth at the local market level, Anthem has established a new business unit called the Diversified Business Group. The Diversified Business Group is a solutions-oriented business unit within the Company that will support Anthem and other external clients in the pursuit of transforming healthcare. Responsible for the development of new client accounts. Potential clients include: health plans and health benefits administrators/TPAs, employer groups, benefit consultants, state and federal government entities (i.e. CMS, state Medicaid), healthcare providers and integrated delivery systems/accountable care organizations (ACO). Primary duties may include, but are not limited to: Develops strategies and executes plans to identify, target, and secure new sales to achieve goals in growth, profitability, retention, and strategic value. Sells the DBG value proposition to Medicaid / Commercial and Specialty Business Division. Provides consultative subject matter expert information on the suite of products offered by DBG. Designs and implements standard and customized bundles of DBG services to seize unique cost-of-care and quality improvement opportunities for client groups. Builds effective relationships with internal and external stakeholders. Understands the issues specific to the client and applies knowledge, insight and experience into strategic recommendations. Understands the business processes that the system supports. May develop product and sales support messaging and materials, and provide input into the design of an account planning and renewal strategy. Qualifications Requires a BA/BS in health care related field; 7 years of experience in account management, sales and/or operations in the health care industry; or any combination of education and experience, which would provide an equivalent background. MBA preferred. Requires a successful track record of selling specialty care/benefit management services and technology for leading healthcare companies to target customers. Experience with Medicaid insurance strongly preferred. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

 
 

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Description

Job Description:

Leidos is seeking a Business Development Professional to lead the business development and capture activities within our Centers for Medicare & Medicaid (CMS) portfolio.  This position location is in the Baltimore, MD area with local and extended travel expected up to 10% of the time.  The position is focused on identifying, qualifying, and capturing opportunities within CMS programs, continuing to build the Leidos reputation and business pipeline, executing the BD process, maintaining a high win probability, and growing business within the CMS domain.

Primary Responsibilities:

• Proactively identify new business opportunities.  Perform market research to qualify new business opportunities, including analysis of customer budgets, capabilities required, current customer preferences, competitive environment assessments, and incumbent strengths and weaknesses.
• Coordinate and conduct meetings with customers, competitors, clients, and teammates to develop market insight on requirements, acquisition strategy, acquisition timing, and contract vehicle choices.
• Work with program and management team in call plan development and execution, and provide detailed reports on follow up activities after plan execution.
• Serve as Capture Manager for selected opportunities, either all the way to award or in the early capture phase.
• Participate as required in the Leidos business development process, including pipeline reviews, opportunity gate reviews, black hat sessions, and proposal reviews.
• Collaborate with Leidos Account Managers, IDIQ PMs, other BD personnel and capture and line management to support cross enterprise objectives and customer engagement.
• Support overall strategic planning and linking pursuits/capture activities which support the business development metrics for awards, submits, and pipeline.
• Interact routinely with various levels of management, functional leads, other staff, and customers.
• Brief business development status to senior management when material changes occur and as required by the Leidos business development process.

Basic Qualifications:

• Bachelor’s degree and 12-15 years of prior relevant experience.
• Proven track record of successful business development at a variety of acquisition sizes.
• Demonstrated access to and relationships with key CMS CMMI and CCSQ customers and industry partners.
• Excellent written and verbal communication skills are essential.
• Leadership skills to develop, organize and execute significant BD activities, including building industry teams, assessing win probability, and executing customer call plans.
• Prior experience supporting business development and capture efforts for CMS agencies.
• Strong, respected relationships within the CMS community
• Ability to gain internal support, operate independently with limited supervision and feedback, and establish a solid working relationship with technical staff, division managers, and peers in the Group and across Leidos.
• Self-starter and ability to manage time independently without direct supervision.
• The ability to operate at the senior level and influence, negotiate and close.
• Candidates must be US Citizens and be eligible to obtain a security clearance.

Preferred Qualifications:

• A technical degree is highly desired
• Proximity to CMS Baltimore location desired, but not required

External Referral Bonus:

Eligible

Potential for Telework:

Yes, 10%

Clearance Level Required:

None

Travel:

Yes, 10% of the time

Scheduled Weekly Hours:

40

Shift:

Day

 
 

Clipped from: https://careers.leidos.com/jobs/6275861-business-development-professional-cms-centers-for-medicare-and-medicaid?tm_job=R-00048950-OTHLOC-PL-2D0230&tm_event=view&tm_company=2502&bid=521

 
 

You will:

• Support the delivery of services to clients on time, within scope, and within budget, including assigning and managing staff and creating work product
• Deliver frequent, clear, and consistent communication to the client, team members, vendor, and direct reports
• Develop, review, distribute, and present project status reports
• Lead the documentation of project action items, issues, risks, and decisions
• Oversee deliverable review facilitation, tracking, and maintenance
• Lead staff/team meetings and trainings
• Perform and delegate administrative tasks efficiently and effectively, asking questions when instructions are unclear
• Provide oversight, facilitation, and assistance across each of the project’s testing related phases (i.e., developing testing, system integration testing, user acceptance testing, operational readiness testing, pilot testing, regression testing, etc.)
• Estimate and maintain resource projections for responsible tasks; assist in the facilitation of stakeholder involvement in project testing efforts; and assist in the development, review, distribution, and presentation of project status reports

Qualifications

You have:

• At least 5 to 7 years of public sector experience
• At least three years of experience working with state Medicaid agencies
• Experience with transformation of business rules into system configurations; business and technical aspects of healthcare information systems; and knowledge of the business areas of the Medicaid Information Technology Architecture (MITA) framework preferred
• Experience with assisting and/or leading testing efforts for a health and human services technology solution implementation
• In-depth understanding of the testing lifecycle, knowledgeable in test execution and defect management (defect identification, documentation, management, and reporting)
• Developed, edited, and presented summaries, reports, and presentations of complex information and data for project and client teams
• Estimated and maintained resource projections for responsible tasks
• Managed a project team
• Strong communication skills and attention to detail
• Bachelor’s Degree (BA/BS)
• Knowledgeabl in quality assurance/control procedures and demonstrated proactive problem management skills
• Demonstrated ability to excel in a team setting
• Strong experience with Microsoft desktop applications
• Prior consulting experience in a national or regional consulting firm, experience working in/with the public sector or relevant independent consulting experience.

 
 

Clipped from: https://www.theladders.com/job/sr-consultant-medicaid-berrydunn-portland-me_46405418?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic

Health Care Service Corporation

Description

Manager Behavioral Health Case Management – Oklahoma Medicaid 5/2/21Full-Time RegularOK – Oklahoma City, OK – Tulsa Refer Save Apply Job ID: BDP-1040783 Description: Job Purpose:This position is responsible for directing, planning, and oversight of the Behavioral Health Clinical Operations teams and program initiatives for Oklahoma Medicaid. Specific functions include providing leadership in the management of the clinical areas; representing the department to internal personnel and external key stakeholders such as providers, regulatory bodies, members and customers; directing the inclusion of behavioral health expertise throughout the enterprise in all clinical areas and external entities; and accountable for budgetary goals being met.Required Job Qualifications: * Registered Nurse or Masters-level Behavioral Health Professional with unrestricted license (independent practice license if BH Professional) in the State of Oklahoma. * 5 years clinical experience. * 2 years case management program oversight experience. * 1 year supervisory or management experience. * Experience utilizing Total Quality Management (TQM)/Continuous Quality Improvement (CQI) concepts. * Knowledge of medical terminology and procedures. * Knowledge of managed care products and programs. * Knowledge or experience using National Committee for Quality Assurance (NCQA) or other accrediting agency standards. * Multiple project leadership and program development skills. * Verbal and written communications skills; interpersonal and organizational skills. * PC proficiency to include Microsoft Windows. * Ability to travel, including overnight stays. * Note must obtain Case Management Certification within four (4) years.Preferred Job Qualifications: * Case Management Certification (CCM). HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. Requirements: Expertise Behavioral Health Behavioral Health Job Type Full-Time Regular Full-Time Regular Location OK – Tulsa, OK – Oklahoma City OK – Tulsa, OK – Oklahoma City

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Medicaid Compliance Lead

Updated today

Aetna Inc.

Baton Rouge, LA 70873

Full-time, Part-time

Refer friends, get paid!

View commute time

Job Description The Medicaid Sr. Compliance Lead position promotes and enforces compliance with state/federal laws and regulations and related-company policies (including the Aetna Code of Conduct) affecting Aetna businesses and encouraging high business standards in order to advance company objectives, benefit the company’s customers, employees and shareholders, and protect the company’s reputation. Responsibilities include: auditing, investigating, training/education and enforcement, ongoing consultation on compliance issues impacting businesses, interfacing with industry groups and regulators on compliance with laws and regulators, monitoring and reporting on adherence to compliance controls, recommending and helping businesses to implement compliance controls. Fundamental Components: * This role will work closely with the CEO, as well as, members of the legal department building successful relationships with stakeholders, client, state/federal authorities and other parties as necessary.
* Oversees compliance activities in support of a large or complex business group and/or manages teams responsible for managing audits and other regulatory exams, inquiries or reporting.
* Works closely with management to drive compliance as a core competency and integrate compliance into business plans, scorecards, metrics, and processes; removes barriers to implementation. This is partnership with the health plan to focus on understanding scope of business and partner with plan to achieve business needs while maintaining compliance.
* Assures the timely implementation of all state and federal legislation and regulations applicable to assigned business areas.
* Ensures that compliance risks are addressed and corrective actions are taken, as appropriate; Assists business units with development and promulgation of appropriate compliance controls/corrective actions.
* Oversees or ensures the development of policies and procedures needed in response to new or existing laws or Company policies.
* Monitors ongoing compliance with the policies and procedures within the business group
* Conducts investigations of compliance deviations or failures.
* Promotes compliance reviews and risk assessments
* Promotes and enforces Aetna’s Code of Conduct and Integrity The Aetna Way
* Promotes compliance awareness, education and training
* Assists with communicating the Company’s business conduct, integrity and compliance messages
* Identifies and analyzes significant legislative initiatives and impact on business operations
* Establishes education programs and provides and/or promotes continuing training & education
* Assures compliance direction is aligned with segment business strategies
* Develops standards of performance and related metrics. Required Qualifications * 7+ years of experience in a regulatory compliance position in managed care, healthcare, or insurance; OR Higher Education with 5+ years of experience in a regulatory compliance position in managed care, healthcare, or insurance
* Position must sit in Louisiana Preferred Qualifications * Audit experience
* Master’s degree or Juris Doctor Education Bachelor’s degree required, preferably in Public Policy, Government Affairs, Business, Public Administration; or related studies Business Overview At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart. We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

 
 

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