San Diego, California

Job Description
As a Medicaid Sr. Compliance Lead, you will promote and enforces compliance with state/federal laws and regulations and related-company policies (including the Aetna Code of Conduct) affecting Aetna businesses and encouraging high business standards in order to advance company objectives, benefit the company's customers, employees and shareholders, and protect the company's reputation.

Responsibilities include:
Auditing, investigating, training/education and enforcement, ongoing consultation on compliance issues impacting businesses, interfacing with industry groups and regulators on compliance with laws and regulators, monitoring and reporting on adherence to compliance controls, recommending and helping businesses to implement compliance controls.

Fundamental Components:
• In this role you will work closely with the CEO, as well as, members of the legal department building successful relationships with stakeholders, client, state/federal authorities and other parties as necessary.
• Oversees compliance activities in support of a large or complex business group and/or manages teams responsible for managing audits and other regulatory exams, inquiries or reporting.
• Work closely with management to drive compliance as a core competency and integrate compliance into business plans, scorecards, metrics, and processes; removes barriers to implementation. This is partnership with the health plan to focus on understanding scope of business and partner with plan to achieve business needs while maintaining compliance.
• Assure the timely implementation of all state and federal legislation and regulations applicable to assigned business areas.
• Ensure that compliance risks are addressed and corrective actions are taken, as appropriate; Assists
business units with development and promulgation of appropriate compliance controls/corrective actions.
• Oversee or ensures the development of policies and procedures needed in response to new or existing laws or Company policies.
• Monitor ongoing compliance with the policies and procedures within the business group
• Conduct investigations of compliance deviations or failures.
• Promote compliance reviews and risk assessments
• Promotes and enforces Aetna's Code of Conduct and Integrity The Aetna Way
• Promote compliance awareness, education and training
• Assists with communicating the Company's business conduct, integrity and compliance messages
• Identify and analyzes significant legislative initiatives and impact on business operations
• Establishes education programs and provides and/or promotes continuing training & education
• Assure compliance direction is aligned with segment business strategies
• Develop standards of performance and related metrics.

Required Qualifications
-7+ years of experience in a regulatory compliance position in managed care, healthcare, or insurance; OR Higher Education with 5+ years of experience in a regulatory compliance position in managed care, healthcare, or insurance

-Position is located in the greater San Diego, California area

COVID Requirements
CVS Health requires its Colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, or religious belief that prevents them from being vaccinated.

If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

If you are unable to be fully vaccinated due to disability, medical condition, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
-Audit experience

Bachelor's degree required, preferably in Public Policy, Government Affairs, Business, Public Administration; or related studies

Business Overview
At CVS Health, 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 strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. 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

San Diego, California

Continue serving and work with a purpose

As a CVS Health colleague, you'll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone's life, including your own. Learn more about how you can continue serving on your next mission at CVS Health.

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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