Responsible for the management, execution, and oversight of the compliance program activities and deliverables of a Medicaid managed care organization
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
Independently prepares and oversees the submission of complex regulatory reports and deliverables as needed
Facilitates the preparation for and management of external audits conducted by state Medicaid and related agencies or partners
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
Develop compelling, strategic, and appropriate compliance related communications
Maintain an in-depth working knowledge of the health plan’s contractual, regulatory, and program policy related obligations
Identify key areas of risk or concern and conduct oversight and monitoring to evaluate levels of compliance; support business partners in the development of mitigation and corrective action plans
Maintain positive, productive relationships with internal and external senior level constituents
Provide training and guidance to less experienced team members

Minimum of 7 years regulatory compliance experience in managed care, health care, or insurance
Minimum of 1 year project management experience
Experience with Medicaid or Medicaid managed care
Audit experience
Bachelor’s Degree preferably in Public Policy, Government Affairs, Health Care Administration, or Public Administration; equivalent years of related professional work experience may substitute
Master’s degree or Juris Doctor preferred.

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 and many other benefits depending on eligibility.

Senior Manager, Medicaid Compliance

Key skills