Business Compliance Manager

April 11

🦌 Connecticut – Remote

Although this job is listed in Connecticut, this company may be open to hiring remote in other states.

🥔 Idaho – Remote

Although this job is listed in Idaho, this company may be open to hiring remote in other states.

+2 more states

🦌 Connecticut – Remote 🥔 Idaho – Remote 🤠 Texas – Remote 🍁 Vermont – Remote

💵 $54.3k - $159.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

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CVS Health

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CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

Retail • Pharmacy Benefits Management • Health Insurance • Health Care • Pharmacy

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

📋 Description

• Lead a team of Quality Reviewers to assess healthcare fraud and abuse • Oversee planning and execution of quality reviews for investigations • Provide direction and counsel on case handling and issue resolution • Conduct comprehensive case reviews and provide feedback to team members • Evaluate team members and provide performance feedback for development • Manage team workload for equitable distribution of cases • Assess training needs and create development plans for team members • Develop relationships with law enforcement to support investigations • Participate in state meetings ensuring compliance with contractual requirements • Coordinate with compliance and senior leadership on program integrity initiatives • Contribute to educational awareness and training programs

🎯 Requirements

• Minimum of five years of experience managing healthcare fraud, waste, and abuse investigations • At least four years of people leading experience is required • Documented record of leading a team greater than eight colleagues • Experience collaborating with state and law enforcement partners • Experience in project management, managing multiple priorities and projects simultaneously • Strong verbal and written communication skills • Ability to interact effectively with diverse groups and provide timely assistance • Proficient in researching information and identifying relevant resources • Comprehensive knowledge in Microsoft Word, Excel, Outlook, SharePoint, QuickBase Management, and Visio • Strong analytical skills supporting data-driven decision-making • Ability to travel up to 20% (approximately 6-9 times per year)

🏖️ Benefits

• Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs including wellness screenings, tobacco cessation, and weight management programs • Confidential counseling and financial coaching • Benefit solutions including paid time off, flexible work schedules, family leave, and tuition assistance • Retiree medical access and other benefits depending on eligibility