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Position Summary
***This position is to be filled within the state of Maryland
This role leads and manages the compliance program for Aetna's Maryland Medicaid health plan. The Compliance Officer ensures the health plan follows all state Medicaid regulations, contract requirements, and company policies. The position works closely with state agencies, internal business partners, and compliance team members to identify risks, manage audits, and promote ethical and compliant operations.
Key Responsibilities- Serve as the Compliance Officer for Aetna's Maryland Medicaid health plan.
- Act as the primary contact with the Maryland Medicaid agency for compliance and contract-related matters.
- Track, monitor, and submit required regulatory reports and responses on time.
- Lead preparation and coordination for state audits, including corrective action plans and issue resolution.
- Manage all aspects of the Medicaid compliance program.
- Research regulatory requirements and provide recommendations to support compliant business practices.
- Draft and coordinate responses to inquiries and requests from state Medicaid agencies.
- Maintain expert knowledge of Medicaid regulations, contracts, and program requirements.
- Serve as a compliance resource for staff, providing guidance, education, and training.
- Maintain compliance tools, risk assessments, reporting systems, and tracking processes.
- Identify compliance risks, conduct monitoring activities, and recommend corrective actions.
- Support business teams in developing solutions to address compliance concerns.
- Utilize compliance management tools, including Microsoft Office and Archer.
- Build and maintain strong relationships with internal and external stakeholders.
- Provide guidance and coaching to less experienced team members.
- Perform other duties as assigned.
- 7+ years of compliance experience in healthcare, managed care, insurance, or a related field.
- Candidates with an advanced degree may qualify with 5+ years of relevant experience.
- Project management experience.
- Experience with Medicaid or Medicaid managed care programs.
- Experience supporting audits or regulatory reviews.
- Bachelor's degree in Public Policy, Government Affairs, Healthcare Administration, Public Administration, or a related field.
- Master's degree or Juris Doctor (JD).
Education
- Bachelor degree OR equivalent experience.
Pay Range
The typical pay range for this role is:
$82,940.00 - $182,549.00
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. This position also includes an award target in the company’s equity award program.
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 7+ years of compliance experience in healthcare, managed care, insurance, or related field
- Advanced degree may qualify with 5+ years of relevant experience
- Project management experience
- Bachelor degree or equivalent experience
- Position must be filled within the state of Maryland
- Familiarity with Microsoft Office
- Familiarity with Archer (compliance/GRC tool)
- Experience with Medicaid or Medicaid managed care programs
- Experience supporting audits or regulatory reviews
- Bachelor degree in Public Policy, Government Affairs, Healthcare Administration, Public Administration, or related field
- Master's degree or Juris Doctor (JD)
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
