Senior Manager, Medicare Business Compliance

At Aetna®, part of CVS Health, we proudly serve more than 26 million medical members through our broad range of health plan offerings. We're committed to delivering a simpler, more meaningful, and personal health care experience to each of them.

As a Senior Manager Business Compliance (Medicare) you will play a critical role by leading and delivering complex compliance initiatives that support regulatory adherence and operational excellence. This role partners closely with cross-functional business areas to plan, coordinate, and execute projects that mitigate operational and regulatory risk, with a strong emphasis on Medicare compliance.

This position is a senior-level project management position within Operations Integrity and offers broad exposure to internal business partners and leadership teams and provides the opportunity to demonstrate leadership, strategic thinking, and enterprise-level influence.

In this role, you will:

• Oversee the implementation and ongoing interpretation of Medicare laws, regulations, and regulatory guidance, ensuring timely and accurate execution across impacted business areas.
• Serve as a subject matter resource for inquiries and lead responses to audit and data requests from regulators, auditors, and internal oversight partners.
• Interpret regulatory guidance, assess compliance gaps, identify root causes, and design and implement sustainable corrective action plans. 
• Routinely communicate project status, risks, and outcomes to senior leaders and executive stakeholders, translating complex regulatory requirements into clear, actionable business guidance.
• Oversight of new and updated regulatory guidance implementation, leadership of Annual Enrollment Period (AEP) readiness activities across multiple business areas, proactive identification and mitigation of operational risks, and end-to-end coordination of audit and regulatory responses. 
• Contributes to regulatory compliance, operational stability, and overall member satisfaction.

 
Required Qualifications

• ·Project Management: 5+ years of experience leading complex initiatives from planning through execution and delivery.
• Systems Expertise: Hands-on experience with QuickBase.
• Communication Skills: Demonstrated strong oral and written communication skills.
• Executive Communication: Proven ability to communicate effectively with leaders at all levels, including executive leadership.
• Problem Solving & Decision Making: Strong analytical skills with the ability to assess issues, evaluate options, and make sound decisions.
• Collaboration & Teamwork: Adept at working collaboratively across cross-functional teams to achieve shared goals.
• Growth Mindset: Demonstrated agility and commitment to continuous learning, development, and coaching of others.
• Execution & Delivery: Strong capability in planning, delivering, and supporting initiatives to achieve intended outcomes.
• Regulatory Expertise: Strong knowledge of Medicare regulations and regulatory guidance.

Preferred Qualifications

• 5+ years Medicare operational experience
• Aetna systems experience
• Regulatory compliance experience

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We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week.

Aetna Service Operations office/hub locations will be discussed with the selected candidate.

Education

• Bachelor’s degree or equivalent work experience