Sr Manager- Business Compliance (IC)

Job DescriptionSummary:Senor level position that applies expertise in compliance, legal and communication skills to support, manage and help develop compliance strategies. Responsibilities include: monitoring, investigating, training/education, enforcement, reporting, collaborating and consulting with business leaders, and engaging with key stakeholders on compliance related issues to meet regulatory and legal obligations and prevent, detect and mitigate compliance risks.Functional: Leads, implements, and maintains an effective Compliance program supporting First Health, Aetna Signature Administrators, and American Health Holding, including, but not limited to, risk assessment, auditing and monitoring, maintaining effective compliance policies and procedures, and effective communication and training. Prepares highly complex regulatory reports, filings and follow-ups, and manages highly complex regulatory review and audit activities. Independently manages multiple highly complex regulatory interactions including drafting regulatory correspondence, responding to regulatory inquiries and negotiating resolution of regulatory matters requiring a sophisticated understanding of business processes and regulatory requirements. Leads highly complex compliance business process reviews, corrective actions and other projects involving internal and external constituents. Independently develops strategy, processes, forms and related materials to meet the most complex regulatory and legal requirements. Builds and maintains positive, productive relationships with internal and external constituents at the most senior and regulatory organizational levels, and is able to remove significant barriers, drive decision-making and influence ethical and compliant outcomes at all organizational levels necessary to accomplish goals. Independently identifies and assesses the most complex compliance issues and risks, engages appropriate enterprise resources, supports internal and external constituents in the development and monitoring of effective corrective action, error prevention and risk mitigation plans and related activities and communications. Responds to the most complex requests for information within area of responsibility from internal and external constituents. Acts as resource and subject matter expert for colleagues and effectively guides teams to accomplish complex goals.Pay RangeThe typical pay range for this role is:Minimum: 75,400Maximum: 158,300Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications8+ years' experience in a regulatory compliance position in healthcare. Demonstrated working knowledge of Federal laws concerning health care and health insurance law including federal healthcare reform, HIPAA, ERISA, and federal mental health parity. Demonstrated working knowledge of state insurance laws, and the relationship between state and federal laws. Have or able to quickly develop an understanding of Aetna's products and services.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsWorking knowledge of Consolidated Appropriations Act with emphasis on the No Surprises Act Familiarity with provider directory requirements and lawsExperience with clinical operations - UM, CM, DMExperience with URAC accreditation requirementsExperience providing legal advice and counsel to internal customers preferredEducationJD preferredBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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.

Created: 2025-09-06