Phoenix, Arizona

Job Description
This Position is open to work at home (telework) for the following States - Florida, Maryland, California, Texas

This position is responsible for monitoring Medicaid and related regulations and policy changes impacting clinical operations; participating in audits; supporting tracking and submission of Medicaid State Contract(s) related deliverables, including fulfillment of internal and contractual reporting requirements; working with other areas of the organization on the development, testing and implementation of organization, process and system changes to ensure the requirements of the Medicaid program are met enterprise-wide.


• Serves as the clinical point of contact for state regulatory agencies to address contract compliance concerns, member/provider complaints and regulatory reporting timeliness
• Provides leadership and consultation in all aspects of clinical programs as it relates to compliance with the regulatory agencies, state laws and policies, including attending state meetings
• Collaborate with senior leaders in the local market and clinical program management (Care, LTSS and Utilization Management) in the delivery and compliance with state contract and regulatory requirement
• Lead and manage the development, review and delivery of market specific clinical reporting requirements both scheduled and adhoc
• Support development teams with regulatory questions and requests.
• Lead development of responses to regulatory authorities’ requests for information.
• Maintain responsibility for keeping abreast of changes and proposed changes to the assigned market regulatory requirements related to our clinical programs and processes.
• Timely completion of all required reports to applicable regulatory agencies, such as applications, Periodic Performance reviews, corrective action plans, measures of success and reportable changes in institutional leadership or services as required.
• Coordinates the development, implementation, follow-up and evaluation of corrective action plans in response to external accreditation bodies' citations and/or audit bodies when there are identified areas for improvement.

Required Qualifications
- A minimum of 3-5 years of direct experience in Regulatory Affairs
- 3-4 years working experience management Medicaid managed care clinical programs
- Strong knowledge and experience in regulatory submissions
- Regulatory Project Management skills required
- Excellent analytical and writing skills
- Effective interpersonal communication skills
- Time and project managemen
- Superior Competency in MS Word, Adobe Acrobat, PowerPoint, and Excel
- Ability to work independently and under pressure (able to prioritize tasks, deadline oriented, good organizational and problem-solving skills, follow-up skills).
- Committed attention to detail: accurate and meticulous

Preferred Qualifications
Please review required qualifications above

Education
Bachelor's degree or equivalent experience

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. See Job Description

Phoenix, Arizona

Continue serving and work with a purpose

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Careers for Veterans and Military Spouses

 

"The military has an ethos that is grounded in purpose-driven service that’s bigger than the individual. The same holds true for us at CVS Health. You can talk to colleagues in any part of our business and they will be able to articulate our company’s purpose. Working here provides an opportunity for service members and military spouses to continue to serve, just in a civvies."

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