Senior Manager, Corporate Compliance (Medicare Duals) at CVS Health

Downers Grove, Illinois, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

Experienced/career level in compliance with compliance, regulatory, business, analytical, and communication skills
Ability to work independently and collaboratively with internal senior level corporate compliance and business teams in a highly complex regulatory and matrixed organization environment
In-depth working knowledge and expertise in Medicare, Medicaid, and State requirements, regulations, and contracts, with a focus on supporting special needs plans (SNPs)
Proficiency in tracking, analyzing, researching, interpreting, and monitoring CMS and state regulations and government contract requirements
Skills in utilizing and maintaining current information in systems such as Microsoft products and compliance-specific tools like Archer

Responsibilities

Serve as plan compliance officer for assigned Special Needs Plans (SNPs)
Lead and implement an effective Compliance Program as described in CMS Medicare Managed Care Manuals/regulations, applicable Medicaid rules, and government contracts, including risk assessment, auditing and 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
Track, analyze, research, interpret, and monitor applicable CMS and state regulations and government contract requirements to develop recommendations, direction, and escalation, ensuring implementation and integration complies with federal and state specific program requirements and the CVS Code of Conduct
Facilitate compliance and contract-related communications, deliverables, and activities with regulators
Manage timely and accurate responses and tracking of multiple complex regulatory interactions, including frequent meetings with regulators, developing or assisting in strategic written responses to compliance-related inquiries
Lead and/or support external regulatory review and audit activities, including preparation, management of audits by state Medicaid and related agencies, 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 Medicare Compliance Work Plan and direct other projects as assigned to evaluate compliance, propose remediation, and monitor implementation of corrective action

Skills

Medicare Compliance

Medicaid Compliance

Compliance Program Management

Risk Assessment

Auditing

Monitoring

Corrective Action

CMS Regulations

Medicare Managed Care

Special Needs Plans

Regulatory Compliance

Stakeholder Management

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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