Compliance Manager

Key Responsibilities

• Manage APCD compliance programs and reporting requirements across multiple states.
• Lead projects from start to finish, including timelines, regulator communications, and extension requests.
• Interpret state regulations and convert them into business and system requirements.
• Oversee timely submission of reports, files, and responses to regulators and vendors.
• Investigate compliance, reporting, and system issues; identify root causes and support corrective actions.
• Write detailed business requirements to address compliance and data issues.
• Use reporting tools, databases, and data analysis to monitor compliance and improve processes.
• Identify opportunities to automate and streamline workflows.
• Train, mentor, and coach team members and business partners.
• Develop and maintain training materials, policies, procedures, and process documentation.
• Build relationships across departments to improve collaboration and results.
• Communicate effectively with regulators, vendors, clients, account managers, IT teams, and leadership.
• Escalate risks, issues, and compliance concerns when appropriate.
• Create management reports and provide recommendations for issue resolution.

Required Qualifications

• 5+ years of compliance or legal experience in healthcare, insurance, or financial services.
• 5+ years of experience with healthcare products, including: HMOP, POMedicare Advantage, Medicare Part D.
• 2+ years of pharmacy-related experience, including: Specialty drugs, Medicare Part D, BSM (Pharmacy Benefit Manager) operations.
• Understanding of healthcare claims processing and industry coding structures.
• Ability to travel up to 10%.

Preferred Qualifications

• 4–6 years of data analysis and interpretation experience.
• 5–8 years of experience using tools such as SAS, SQL, ACL, Excel, databases, and Microsoft Office.
• Strong experience working with and analyzing large datasets.
• 8+ years of healthcare industry experience, including interpreting state and federal regulations.
• 3–5 years of project management and process improvement experience.
• 3+ years of direct compliance experience involving regulatory agencies.

Key Skills

• Strong project management and organizational skills.
• Ability to manage multiple priorities and deadlines.
• Excellent written and verbal communication skills.
• Ability to influence business processes, policies, and system improvements.
• Strong analytical and problem-solving abilities.
• Experience identifying trends, conducting root-cause analysis, and improving data quality.
• Ability to build relationships and collaborate across teams.

Education

• Bachelor’s degree or equivalent work experience.

Pay Range

The Typical Pay Range For This Role Is $66,330.00 - $145,860.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.