DirectJobHub
Jobs · Legal · Arizona

Manager, Medicaid Compliance

CVS Health · Phoenix, AZ · 1 mo ago
HybridLegal$60k/yrFull-time
We need to output HTML fragment with sections: About the role? The posting includes a paragraph about CVS Health mission etc. That could be "About the role" or maybe "About the company". The instructions: use

for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). We must include sections only when posting has real specific content. We have: - Position Summary (could be About the role) - Responsibilities (list) - Required Qualifications (list) - Preferred Qualifications (list) - Education (maybe part of qualifications) - Anticipated Weekly Hours 40 (Schedule) - Time Type Full time (maybe Schedule) - Pay Range (Pay) - Benefits (Benefits) - Additional details: application window close date (metadata) maybe not needed as heading; we can fold into a short

or drop. The instruction: do NOT put Job ID/requisition numbers as headings — fold minor metadata into a short

or drop it. So we can include a short

for application window close date. We must remove boilerplate: cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. The posting includes "Qualified applicants with arrest or conviction records will be considered..." that's EEO; we should remove that. Also "Our people fuel our future..." etc maybe not boilerplate but could be considered generic; but it's about benefits and culture; maybe keep as part of Benefits? It's more about culture; but we can keep as part of Benefits section? The instruction: remove EEO/equal-opportunity/scam-warning boilerplate. So remove that line. Also remove duplicated lines. We need to preserve all substantive information. Let's extract content: Mission paragraph: "We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time." That's about the company; could be placed under About the role or maybe a generic intro. We'll put under

About the role

with that paragraph. Position Summary: "As a Medicaid Compliance Manager, you are in an experienced/career level compliance position that supports the compliance program activities and deliverables of a Medicaid managed care organization. In partnership with and under the direction of the health plan Compliance Officer, this position will help develop and maintain systems and processes that demonstrate the principles of an effective Compliance program and promote compliant and ethical behavior in our Medicaid health plans." We could include that as part of About the role or separate. Since we already have About the role, we could combine mission and position summary into that section. But better to keep About the role as mission + position summary. Responsibilities: list bullet points. Let's extract responsibilities list: - Maintain the systems and tools to track, monitor, review, and submit required regulatory and compliance related deliverables and responses to Arizona Medicaid agencies on or before required due dates; prepares moderately complex regulatory reports as needed on behalf of the Medicaid compliance team - Conduct research and develop recommendations to help develop compliant business operations, processes and policies in accordance with Arizona specific Medicaid program requirements - Develop compelling and appropriate compliance related communications on behalf of Mercy Care in response to Arizona Medicaid agency inquiries or requests - Maintain an in-depth working knowledge of the Mercy Care’s contractual, regulatory, and program policy related obligations as a Medicaid managed care organization and serve as a resource to Mercy Care and Medicaid growth partner staff for education and business decision making purposes - Manage and support the external audit review process in conjunction with designated subject matter experts at Mercy Care, including, but not limited to the project management and tracking of required deliverables, responses, and corrective action plan development (through closure) - Maintain 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 as needed to ensure the appropriate monitoring and oversight of Mercy Care and Medicaid compliance processes - 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 - Conduct oversight and monitoring to evaluate levels of compliance with Mercy Care 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 constituents to effectively communicate and influence ethical and compliant outcomes - Provide training and guidance to less experienced team members to accomplish goals - Other duties as assigned We need to put each as
  • inside
      . Required Qualifications: - Minimum of 5 years of regulatory compliance position in managed care, health care, or insurance - Project management experience Preferred Qualifications: - Experience with Medicaid or Medicaid managed care - Experience with audit coordination and policy management Education: - Bachelor’s Degree preferably in Public Policy, Government Affairs, Health Care Administration, or Public Administration; equivalent years of relevant work experience may substitute - Masters degree or Juris Doctor preferred We could combine Education under Qualifications or separate. The instruction list includes Qualifications as a heading; we could have Required Qualifications and Preferred Qualifications under Qualifications? But they said use headings like Requirements, Qualifications, Skills, Benefits, Pay, Schedule. So we can have

      Qualifications

      and inside we can have subheadings? Not allowed; only headings are h3. Could we have separate sections: Required Qualifications and Preferred Qualifications as separate h3? The examples didn't list those exactly but they said use h3 for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). So we can have Required Qualifications and Preferred Qualifications as sub-sections under Qualifications? But we cannot use h4. Maybe we can just have Qualifications section and list both required and preferred within it, maybe with or plain text. But we need to preserve all info; we can separate with paragraphs. Better: Use

      Qualifications

      then inside have

      Required:

      then
        for required, then

        Preferred:

        then
          for preferred. That's acceptable. Education could be part of Qualifications as well. Pay: we have Pay Range: $60,300.00 - $132,600.00 plus description. We'll make

          Pay

          with

          containing that info. Schedule: Anticipated Weekly Hours 40, Time Type Full time. We'll make

          Schedule

          with

          Full‑time, 40 hours per week.

          Benefits: description: "Great Benefits For Great People ... This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility." Also earlier: "Our people fuel our future..." maybe part of benefits but we can keep as part of Benefits section. We'll output only HTML fragment. Let's craft:

          About the role

          We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

          As a Medicaid Compliance Manager, you are in an experienced/career level compliance position that supports the compliance program activities and deliverables of a Medicaid managed care organization. In partnership with and under the direction of the health plan Compliance Officer, this position will help develop and maintain systems and processes that demonstrate the principles of an effective Compliance program and promote compliant and ethical behavior in our Medicaid health plans.

          Responsibilities

          • Maintain the systems and tools to track, monitor, review, and submit required regulatory and compliance related deliverables and responses to Arizona Medicaid agencies on or before required due dates; prepares moderately complex regulatory reports as needed on behalf of the Medicaid compliance team
          • Conduct research and develop recommendations to help develop compliant business operations, processes and policies in accordance with Arizona specific Medicaid program requirements
          • Develop compelling and appropriate compliance related communications on behalf of Mercy Care in response to Arizona Medicaid agency inquiries or requests
          • Maintain an in-depth working knowledge of the Mercy Care’s contractual, regulatory, and program policy related obligations as a Medicaid managed care organization and serve as a resource to Mercy Care and Medicaid growth partner staff for education and business decision making purposes
          • Manage and support the external audit review process in conjunction with designated subject matter experts at Mercy Care, including, but not limited to the project management and tracking of required deliverables, responses, and corrective action plan development (through closure)
          • Maintain 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 as needed to ensure the appropriate monitoring and oversight of Mercy Care and Medicaid compliance processes
          • 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
          • Conduct oversight and monitoring to evaluate levels of compliance with Mercy Care 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 constituents to effectively communicate and influence ethical and compliant outcomes
          • Provide training and guidance to less experienced team members to accomplish goals
          • Other duties as assigned

          Qualifications

          Required:

          • Minimum of 5 years of regulatory compliance position in managed care, health care, or insurance
          • Project management experience

          Preferred:

          • Experience with Medicaid or Medicaid managed care
          • Experience with audit coordination and policy management

          Education:

          • Bachelor’s Degree preferably in Public Policy, Government Affairs, Health Care Administration, or Public Administration; equivalent years of relevant work experience may substitute
          • Masters degree or Juris Doctor preferred

          Pay

          The typical pay range for this role is $60,300.00 - $132,600.00 (base hourly rate or base annual full‑time salary). Actual base salary offer will depend on factors such as 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.

          Benefits

          Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

          Great Benefits For Great People: This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues

    • Similar jobs