Medicare Compliance Consultant (Oklahoma City)

Medicare Compliance Consultant

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

The Medicare Compliance Consultant is a compliance role that supports the compliance program activities and deliverables of a Medicare managed care organization. In partnership with and under the direction of the health plan, Medicare Compliance Officer, and other team members, 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 Medicare Advantage health plans.

Responsibilities include, but are not limited to :

• Maintain an in-depth working knowledge of the health plan's contractual, regulatory, and program policy related obligations as a Medicare Advantage organization.
• In partnership with other senior members of the team, assist with the oversight and monitoring activities used to evaluate the levels of compliance with the Medicare Part C and Part D regulations.
• Provide support for the elements and compliance department responsibilities required under the Medicare Compliance Program, which include (but are not limited to) meeting attendance, capturing meeting minutes, OIG (Office of Inspector General) / GSA (General Services Administration) screening of board members, monitoring compliance mailbox, tracking and assisting responses to compliance inquiries, and serving as a resource to health plan staff.
• Effectively escalate identified risks, concerns, and other issues through appropriate channels.
• Maintain the systems and tools used to track, monitor, review, and communicate Medicare Advantage Part C and D contract deliverables.
• Review, interpret, and distribute regulatory guidance materials, and track required health plan implementation timeframes.
• Support external and internal audit processes in conjunction with senior members of the team; including (but not limited to) project management and tracking of required audit deliverables.
• Utilize systems unique to job functions, including standard-issue software such as Microsoft products and compliance specific tools; maintain system documentation.
• Maintain positive, productive relationships with internal and external constituents to effectively communicate and influence ethical and compliant outcomes.
• Other duties as assigned.

Required Qualifications :

Preferred Qualifications :

Education :

Anticipated Weekly Hours : 40

Time Type : Full time

Pay Range : The typical pay range for this role is : $43,888.00 - $102,081.00

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.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include :

For more information, visit https : / / jobs.cvshealth.com / us / en / benefits

We anticipate the application window for this opening will close on : 10 / 01 / 2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex / gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.