Manager, ACO Compliance

Job Description
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

***This role follows a hybrid working schedule of three days onsite and two days from home per week***

The Manager, Corporate Compliance will collaborate with the ACO team on Strategic planning to monitor and oversee the implementation of business initiatives in a compliant manner. This role is also responsible for ensuring the business complies with identified new laws and regulations and maintains open lines of communication with the CVS ACO leadership team and key stakeholders to ensure processes are enhanced or implemented to effectively address compliance requirements.

This position will work independently as well as in collaboration with leaders across the organization. The Manager will work with and influence decision makers within Compliance, Legal, and the CVS ACO Health teams.

Responsibilities:

• Support business initiatives and compliance related inquiries.  
• Interface with Business and Compliance leadership and present updates as needed.
• Partner with Business leaders and collaborate on all compliance risk mitigation efforts.
• Evaluate and draft risk assessment review plans in coordination with the Legal and Business partners.
• Lead risk assessments exercise from a project management perspective.
• Extract and compile meaningful recommendations to address any unmitigated risk.
• Collaborate with the business to validate and track all correction plans.
• Act as the business compliance officer for the ACO business lines as needed.
• Work with the Business to Implement mitigation plans and monitor business segment compliance with any external regulatory findings. 
• Establish working relationships with process owners to drive and implement business practice enhancements to increase the compliance program effectiveness.
• Actively participate in applicable business working groups/committees for areas of responsibility.
• Act as a Business Compliance Office lead in Risk Assessments on Subject Matter areas to identify regulatory risks, business controls, and establish Compliance oversight.
• Partner with the Center of Excellence team to address and implement solutions with the business for Global and High-Risk findings as needed.
• Assist in identification of high-risk compliance impact areas for audit purposes.
• Evaluate Compliance audit results and identify global and wide scope items.
• Collaborate with the business to address audit gaps based.
• Assist with investigations, including interview/fact finding and analysis, presentation of recommendations to executive leadership, and remediation/root cause process enhancements.
• Represent Compliance Department at various business leadership meetings.
• Review new mandates (laws and regulations) and coordinate with Legal and Regulatory partners to identify applicability to the business segment.
• Serve as a subject matter expert to identify relevant regulatory areas.
• Receive and review relevant new laws and work with the Legal and Business partners to address any new requirements.
• Establish Compliance monitors as needed.
• Perform additional duties as assigned

Required Qualifications

• 5+ years of healthcare compliance experience and/or ACO operational experience, or a combination of both.

Preferred Qualifications

• Knowledge of ACO operations and/or ACO compliance requirements.
• Thorough knowledge in the following areas:
  • Medicare ACO compliance.
  • ACO REACH program compliance requirements.
  • Medicare MSSP ACO program compliance requirements.
• Knowledge of government regulations related to a complex health care company with working knowledge of:
  • The Anti-Kickback Statute.
  • FWA.
  • Stark Law.
  • Medicare.
  • Medicaid.
  • Other government reimbursement programs.

Education

• Bachelors degree or equivalent years of experience.

Pay Range
The typical pay range for this role is: $63,300.00 – $139,200.00.

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.  
 
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

CVS 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.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health colleagues can initiate a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through myHR (1-888-694-7287, or through myLeave at myHR). If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.