Medicaid Compliance Officer
CVS Pharmacy - New York City, NY
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Job DescriptionThis position requires candidates to live in the state of New YorkThe Medicaid Compliance Officer 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 Qualifications7 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 insuranceCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsAudit experienceBachelor's degree preferably in Public Policy, Government Affairs, Business, or Public AdministrationMaster's degree or Juris DoctorEducationBachelor's degree requiredBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Created: 2024-09-07