Job Information
CVS Health Program Integrity Manager in Topeka, Kansas
Bring your heart to CVS Health. Every 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.
Position Summary
Serves as the Special Investigations Unit single point of contact for Kansas State Medicaid programs for all program integrity related issues. This includes regulatory reporting, coordinating interdepartmental program integrity initiatives, vendor oversight of fraud waste and abuse (FWA) activity, and identifying services at risk for FWA. You will be responsible for compliance with state and federal regulations mandating the reporting of corporate fraud related activities and the preparation of the corporate Anti-Fraud Plan.
Additionally, you will:
Utilize your experience and knowledge to comprehend and implement Medicaid regulations and contracts
Coordinate with department leaders to fulfill the requirements of the program integrity unit
Comply with all program integrity related requests, both internal and external, and meet request timelines
Ability to handle and maintain confidential and sensitive information pertaining to providers.
Maintain the Annual Fraud Plan, Risk Assessments and Work Plan including any health plan addendums
Collaboration with plan compliance teams, including Audit preparation and Readiness Review oversight
Act as a liaison with state Medicaid agencies, MFCU and other state law enforcement
State reporting oversight and submission, as well as coordination of Vendor FWA activities
Draft requests for proposal on new/rebidding of contracts
Annual plan FWA training
To be successful, you will utilize your excellent stakeholder relationship management skills to collaborate with state partners and internal teams. Your ability to organize and manage multiplies priorities will also be critical to your success.
Required Qualifications
Must be in Kansas (or within the Kansas/Missouri border )
7 years of work experience required (graduate level education may substitute)
3 years of experience in a Healthcare Program Integrity, Medicaid Special Investigation or Medicaid / Medicare / Commercial Compliance role
Experience leading Medicaid audits
Ability to travel up to 10% (approx. 2-3x per year, depending on business needs)
Preferred Qualifications
Experience In Medicaid Compliance, Medicaid Investigations, MCO Medicaid FWA Unit in the following States: Florida, Illinois, Michigan, Maryland, Nebraska, Pennsylvania and Kansas
Experience with Generating / Review Medicaid State Reporting
Experience with Interpreting Contracts
Exceptional Organizational Skills
Excellent Written and Oral Communication Skills
Ability To Interact with All Levels of The Organization.
Working experience with Regulatory Agencies as SME or Lead Point of Contact
Education
- Bachelor's degree or equivalent experience
Pay Range
The typical pay range for this role is:
$60,300.00 - $132,600.00
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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
We anticipate the application window for this opening will close on: 04/24/2024
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.