Lead Director overseeing Medicaid compliance and external audits for CVS Health. Managing external regulatory audits and compliance communications with state Medicaid agencies.
Responsibilities
Serving as the principal liaison to the state Medicaid agency for all external audits and escalated state matters
Facilitating the preparation for and management of external audits conducted by state Medicaid and related agencies or partners through final report and corrective action plan closure
Supervising the submission of all audit deliverables and ad hoc state requests or escalated issues
Conducting comprehensive lessons learned evaluations following post-audit and develop proactive corrective actions with executive leaders
Conducting research and develop recommendations to help executive leadership develop compliant business operations
Independently developing compelling compliance related communications on behalf of the health plan
Maintaining an in-depth working knowledge of the health plan’s contractual, regulatory, and program policy related obligations
Designing and managing tools for tracking and handling complex state external audits
Utilizing systems unique to job functions, including standard-issue software such as Microsoft products and compliance specific tools
Maintaining positive, productive relationships with internal and external senior level constituents
Providing training and guidance to less experienced team members
Requirements
10 years previous experience in Medicaid or Medicaid managed care
2+ years previous experience managing external audits
2+ previous management experience
5+ years regulatory compliance position in managed care, health care, or insurance or 3 years with Master’s Degree
Ability to travel (up to 25% - including plane) to Texas for audit preparations and on-site reviews
Regular and reliable attendance due to time sensitive nature of external deliverables and activities
Benefits
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access
Job title
Lead Director, Medicaid Compliance External Audits
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