Plan Compliance Officer
CVS Pharmacy - Columbus, OH
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Job DescriptionCandidate must be based and working in the state of OhioThe Sr. Compliance Manager is an experienced/career level compliance position that applies compliance, regulatory, business, analytical and communication skills to support, manage and develop Medicare-Medicaid compliance programs and processes that promote compliant and ethical behavior, meet regulatory obligations and prevent, detect and mitigate compliance risks.As the Sr. Compliance Manager and Plan/Business Compliance Officer located within the CVS Health Medicare Compliance Division, the individual will work independently, as well as collaboratively, with the Medicare and Medicaid compliance teams and with business teams that operate MMPs and DSNPs in a highly matrixed environment. The Sr. Manager will monitor, oversee and develop strategies for implementation of the Aetna Better Health of Ohio MMP 2-way and 3-way contracts in a compliant manner. The Sr. Manager is also responsible for ensuring the business complies with identified laws, regulations, contacts and the CVS Code of Conduct. The Sr. Manager Compliance maintains open lines of communication with leadership teams and key internal stakeholders to escalate and ensure processes are enhanced or implemented to effectively address compliance requirements. The Sr. Manager will also lead and support broader compliance initiatives and needs as assigned to ensure that an effective compliance program as described in CMS' Chapters 9 &21 (Compliance Program Effectiveness) and applicable Medicaid rules, are achieved and maintained for MMPs and DSNPs. Responsibilities include, but are not limited to: Implement and lead the Compliance Program and serve as plan compliance officer for Aetna Better Heath of Ohio MMP as described in the 2-way and 3-way contracts. Act as key Compliance subject matter expert for OH MMP to support the requirements of an effective Compliance program Tracks, analyzes, interprets and monitors CMS and state regulations and State contract requirements and provides direction to ensure Aetna's administrative and operational activities related to MMP and DSNP are compliant with regulations Maintains current working knowledge and expertise in Medicare Compliance and State regulations in support of MMP and DSNP plans Monitoring and auditing focused on MMP and DSNP plans as outlined in Medicare Compliance Work Plan to evaluate compliance; proposes corrective action where necessary and monitors implementation of such corrective action Manage and ensure timely and accurate responses and tracking of multiple complex regulatory interactions , including drafting regulatory correspondence, frequent meeting with regulators on compliance with laws and regulations, and responding to regulatory inquiries requiring an understanding of business processes and regulatory requirements and positive relationships with regulators Lead and/or support internal and external audits Submit regulatory reports Appropriately escalate issues requiring resolution Other duties as assignedIn order to be successful in this role you must exhibit the following:-Extensive knowledge of Medicare and Medicaid compliance programs and rules, specifically rule applying to integrated duals plans -Experience in internal and external auditing and monitoring and CAP management validation- Experience in validation of memo, rule and mandate implementation -Experience in regulator interactions -Time management and project management-Proficiency in Excel, Quickbase, compliance management applicationsRequired Qualifications7+ years experience in government healthcare program compliance or regulatory work; ability to travel up to 5%COVID 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 QualificationsJ.D.EducationBachelors degreeBusiness 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