Senior Manager, Medicaid Compliance - Ohio

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As a Senior Manager of Medicaid Compliance, you are responsible for the management, execution, and oversight of the compliance program activities and deliverables of a Medicaid managed care organization operating in a moderately complex regulatory environment. This role will allow you to serve as the designated Compliance Officer for Aetna’s Ohio (OH) Medicaid health plan. You will oversee the activities of other compliance team members assigned to the Ohio market.

You will be responsible for developing and maintaining systems and processes that demonstrate the principles of an effective Compliance program and promote compliant and ethical behavior in the assigned Medicaid health plan.

• Acts as the primary liaison to the state Medicaid agency, facilitating compliance and contract-related communications and activities
• Maintain the systems and tools to track, monitor, review, and submit required regulatory and compliance related deliverables and responses to state Medicaid agencies on or before required due dates; independently prepares and oversees the submission of complex regulatory reports and deliverables as needed on behalf of the Medicaid compliance team
• Facilitates the preparation for and management of external audits conducted by state Medicaid and related agencies or partners in conjunction with health plan leadership through final report and corrective action plan closure
• Lead and execute all elements of the Medicaid compliance program for Aetna’s OH Medicaid health plan
• Conduct research and develop recommendations to help develop compliant business operations, processes, and policies in accordance with state specific Medicaid program requirements
• Develop compelling, strategic, and appropriate compliance related communications on behalf of the health plan in response to state Medicaid agency inquiries or requests
• Maintain an in-depth working knowledge of the health plan’s contractual, regulatory, and program policy related obligations as a Medicaid managed care organization and serve as a resource to health plan and growth partner staff for education, training, and business decision making purposes
• Ensure that 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 are current and accessible to business partners to ensure the appropriate monitoring and oversight of health plan compliance processes
• Identify key areas of risk or concern and proactively conduct oversight and monitoring to evaluate levels of compliance with Medicaid managed care organization 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
• 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
• Lead and direct oversight and monitoring activities to evaluate levels of compliance with new and existing Medicaid managed care organization 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 senior level constituents to effectively communicate and influence…