About this opportunity
Oak St. Health lists this Manager, Medicaid Compliance opportunity in phoenix, Arizona. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Medicaid Compliance Manager
We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
As a Medicaid Compliance Manager, you are in an experienced/career level compliance position that supports the compliance program activities and deliverables of a Medicaid managed care organization. In partnership with and under the direction of the health plan Compliance Officer, this position will help develop and maintain systems and processes that demonstrate the principles of an effective Compliance program and promote compliant and ethical behavior in our Medicaid health plans.
Responsibilities include, but are not limited to:
Maintain the systems and tools to track, monitor, review, and submit required regulatory and compliance related deliverables and responses to Arizona Medicaid agencies on or before required due dates; prepares moderately complex regulatory reports as needed on behalf of the Medicaid compliance team
Conduct research and develop recommendations to help develop compliant business operations, processes and policies in accordance with Arizona specific Medicaid program requirements
Develop compelling and appropriate compliance related communications on behalf of Mercy Care in response to Arizona Medicaid agency inquiries or requests
Maintain an in-depth working knowledge of the Mercy Care's contractual, regulatory, and program policy related obligations as a Medicaid managed care organization and serve as a resource to Mercy Care and Medicaid growth partner staff for education and business decision making purposes
Manage and support the external audit review process in conjunction with designated subject matter experts at Mercy Care, including, but not limited to the project management and tracking of required deliverables, responses, and corrective action plan development (through closure)
Maintain current resource tools and other internal deliverables such as current contract library, regulatory reporting assignments, risk assessments, risk tracking lists, internal reporting systems and summaries, and other department wide tools as needed to ensure the appropriate monitoring and oversight of Mercy Care and Medicaid compliance processes
Utilize systems unique to job functions, including standard-issue software such as Microsoft products and compliance specific tools such as Archer; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenance
Conduct oversight and monitoring to evaluate levels of compliance with Mercy Care requirements across the business; support business partners in the development of mitigation and corrective action plans and effectively escalate risks, concerns and other issues through appropriate channels
Maintain positive, productive relationships with internal and external constituents to effectively communicate and influence ethical and compliant outcomes
Provide training and guidance to less experienced team members to accomplish goals
Other duties as assigned
Required Qualifications:
Minimum of 5 years of regulatory compliance position in managed care, health care, or insurance
Project management experience
Preferred Qualifications:
Experience with Medicaid or Medicaid managed care
Experience with audit coordination and policy management
Education:
Bachelor's Degree preferably in Public Policy, Government Affairs, Health Care Administration, or Public Administration; equivalent years of relevant work experience may substitute
Masters degree or Juris Doctor preferred
Anticipated Weekly Hours: 40
Time Type: Full time
Pay Range: $60,300.00 - $132,600.00
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Worksite address
phoenix, AZ, 85003, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.