Corporate Compliance (Medicare Duals) - Senior Manager

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Position Summary

*** This position follows a hybrid working schedule of three days onsite per week in Southfield, MI***

The 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 and Medicaid compliance programs and processes that promote compliant and ethical behavior, meet regulatory obligations, and prevent, detect and mitigate compliance risks.

The individual will work independently, as well as collaboratively, with internal senior level Medicare compliance and business teams that operate MMP and DSNP products in a highly matrixed environment. The Sr. Manager Compliance maintains productive relationships and open lines of communication with internal and key external stakeholders to effectively communicate and influence compliant outcomes and ensure that processes are enhanced or implemented to effectively address compliance requirements.

Responsibilities include, but are not limited to:

• Lead and implement an effective Compliance Program as described in CMS Medicare Managed Care Manuals and applicable Medicaid rules including risk assessment, auditing and monitoring and lead and support broader compliance initiatives and needs as assigned to ensure that an effective compliance program for MMP and Special Needs Plans is achieved and maintained.

• Develops and manages 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 to ensure Aetna’s implementation of program requirements complies with federal and state specific program requirements and the CVS Code of Conduct

• Maintains current working knowledge and expertise in Medicare Compliance, Medicaid Compliance and State regulations in support of MMP and SNP plans

• Builds and maintains 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 where necessary and monitor implementation of corrective actions to mitigate organizational risk
• Serve as plan compliance officer and act as the primary liaison to the state Medicaid agency and Contract Management Team (CMT) facilitating compliance and contract related communications and activities.
• Manage and ensure timely and accurate responses and tracking of multiple complex regulatory interactions, including frequent meeting with regulators on compliance with laws and regulations, preparing appropriate and strategic written responses to compliance-related regulatory inquiries requiring an understanding of business processes and regulatory requirements and positive relationships with regulators, and report submissions.

• Prepares reports, filings, and follow-ups, and leads and/or supports external regulatory review and audit activities.

• Utilize and maintain current information in systems unique to job functions, such as Microsoft products and compliance specific tools such as Archer
• Other duties as assigned

In order to be successful in this role you must exhibit the following:

-Extensive knowledge of Medicare and Medicaid compliance programs and rules, including rules applying to integrated duals plans
-Experience in validation, auditing and monitoring
-Outstanding time management and project management

-Proficient in utilization of information systems

-Mastery of problem solving and decision making skills

-Adept at execution and delivery (planning, delivering, and supporting) skills

-Adept at collaboration and teamwork

Required Qualifications

7+ years experience in government healthcare program comp