Aetna Director Medicaid Contract Management in Detroit, Michigan

Req ID: 44065BR

POSITION SUMMARY

Responsible for the management of staff accountable for benefit contract language development, regulatory submissions and correspondence, and compliance activities as they relate to Aetna products and programs, entity licensing, product development and implementation; regulatory approvals/work plan relative to Medicaid/Medicare-Medicaid Dual eligible product. (e.g. HMO marketing and advertising compliance; and statutory reporting, regulatory oversight).

Fundamental Components:

Consult on compliance issues impacting the business and provide direction on compliance implementation

Interface and negotiate with state regulators on Aetna business requirements and compliance

Recommend and assist business areas to implement compliance controls

Provide proactive notification to business areas of regulatory requirements and changes

Manage and oversee a staff of managers and consultants, including hire, train and evaluate staff development needs and construct individual development plans

Develop strategic plans for Product and Regulatory Affairs to meet MDHHS/CMS/DIFS filing deadlines and business target dates for product availability

Allocate resources to meet business and operational needs, monitor work allocation and ensure work product is professional and responsibly represents Aetna

Attend SR management meetings as a representative for Product and Regulatory Affairs

Plan strategy, solve problems and make commitments on behalf of the department

Provide timely and effective communication, and promote proactive working relationships with internal and external customers, regulators and insurance groups, and all other areas within Aetna to ensure understanding and appropriate planning to support regulatory change/guidance implementation for Medicaid/MMP

Work closely with attorneys and compliance staff to promote and enforce compliance with state/federal laws and regulations, implement risk management policies

Consult with business and operational areas on compliance issues and regulatory requirements impacting the business and provide direction on compliance implementation and controls

Oversee the development of complete and accurate benefit contract language, and the timely submission and regulatory approval for product and compliance submissions in accordance with state and federal insurance laws and regulations

Monitor and measure response times from regulators and the timeliness of staff member follow-ups and responses on pending filings

Manage priorities to reflect initiatives of ABH-MI core business functions/management

BACKGROUND/EXPERIENCE desired:

Bachelor's degree or higher in Business Administration, Health Admin or other related field.

6 10 years working in Medicaid Managed care or gov. funded products environment

Strong analytical skills; managed care operations/regulatory acumen

Exceptional written/verbal communication skills; ability to convey significant concepts/approaches to regulators

EDUCATION

The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

FUNCTIONAL EXPERIENCES

Functional - Leadership/Act as company spokesperson to external constituents/7-10 Years

Functional - Management/Management - Administration/4-6 Years

FunctionalExperience/FunctionalFocus/4-6 Years

Functional - Government Relations/State/7-10 Years

Functional - Administration / Operations/Management: > 25 employees/7-10 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft PowerPoint/7-10 Years/End User

Technical - Desktop Tools/Microsoft SharePoint/4-6 Years/End User

Technical - Desktop Tools/Microsoft Project/4-6 Years/Power User

TechnicalExperience/TechnicalFocus/4-6 Years/End User

REQUIRED SKILLS

General Business/Applying Reasoned Judgment/MASTERY

General Business/Demonstrating Business and Industry Acumen/MASTERY

Leadership/Anticipating and Innovating/MASTERY

DESIRED SKILLS

Leadership/Developing and Executing Strategy/MASTERY

Leadership/Engaging and Developing People/MASTERY

Service/Working Across Boundaries/MASTERY

ADDITIONAL JOB INFORMATION

  1. Extensive exposure to government funded products administration

  2. Fast paced environment and ability to work on multi-faceted initiatives

  3. Professional growth opportunity

  4. Ability to independently develop programs/best practice models

    Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

    We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

    Together we will empower people to live healthier lives.

    Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

    We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

    Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

    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.

Job Function: Legal