73854BR
Job Description:
This Position is open to work at home (telework) for the following States - Florida, Maryland, California, Texas
This position is responsible for monitoring Medicaid and related regulations and policy changes impacting clinical operations; participating in audits; supporting tracking and submission of Medicaid State Contract(s) related deliverables, including fulfillment of internal and contractual reporting requirements; working with other areas of the organization on the development, testing and implementation of organization, process and system changes to ensure the requirements of the Medicaid program are met enterprise-wide.
Req#:
73854BR
Job Group:
Healthcare
Full or Part Time:
Full Time
Supervisory Responsibilities:
No
Percent of Travel Required:
10 - 25%
Posting Job Title:
Regulatory Clinical Health Services Lead
Potential Telework Position:
Yes
Additional Locations:
CA-Sacramento, CA-San Diego, FL-Tallahassee, KS-Topeka, KY-Louisville, LA-Baton Rouge, MD-Baltimore, NJ-Trenton, TX-Dallas, VA-Richmond, WV-Charleston
Primary Location (City, State):
AZ-Phoenix
EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer
Resource Group:
6
Fundamental Components:
Serves as the clinical point of contact for state regulatory agencies to address contract compliance concerns, member/provider complaints and regulatory reporting timeliness
Provides leadership and consultation in all aspects of clinical programs as it relates to compliance with the regulatory agencies, state laws and policies, including attending state meetings
Collaborate with senior leaders in the local market and clinical program management (Care, LTSS and Utilization Management) in the delivery and compliance with state contract and regulatory requirement
Lead and manage the development, review and delivery of market specific clinical reporting requirements both scheduled and adhoc
Support development teams with regulatory questions and requests.
Lead development of responses to regulatory authorities’ requests for information.
Maintain responsibility for keeping abreast of changes and proposed changes to the assigned market regulatory requirements related to our clinical programs and processes.
Timely completion of all required reports to applicable regulatory agencies, such as applications, Periodic Performance reviews, corrective action plans, measures of success and reportable changes in institutional leadership or services as required.
Coordinates the development, implementation, follow-up and evaluation of corrective action plans in response to external accreditation bodies' citations and/or audit bodies when there are identified areas for improvement.
Background Experience:
A minimum of 3-5 years of direct experience in Regulatory Affairs
3-4 years working experience management Medicaid managed care clinical programs
Strong knowledge and experience in regulatory submissions
Regulatory Project Management skills required
Excellent analytical and writing skills
Effective interpersonal communication skills
Time and project management
Superior Competency in MS Word, Adobe Acrobat, PowerPoint, and Excel
Ability to work independently and under pressure (able to prioritize tasks, deadline oriented, good organizational and problem-solving skills, follow-up skills).
Committed attention to detail: accurate and meticulous
Benefits Program:
Benefit eligibility may vary by position.
Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Clinical Licensure Required:
N/A