Description

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.

Position Summary

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

• 2+ years of experience in regulatory compliance in Medicare Advantage Managed Care.

Preferred Qualifications

• Previous experience with Medicare Part C and D regulations and Medicare Advantage Managed Care.
• Previous project management experience.
• Previous experience in auditing.
• Strong written and verbal communication skills.
• Detail-oriented.

Education

• Bachelor's degree or equivalent experience (high school diploma or GED + 4 years of relevant experience).

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.

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

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:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including 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.

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.