Aetna Director Medicaid Contract Management in Detroit, Michigan
Req ID: 44065BR
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).
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
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
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Leadership/Act as company spokesperson to external constituents/7-10 Years
Functional - Management/Management - Administration/4-6 Years
Functional - Government Relations/State/7-10 Years
Functional - Administration / Operations/Management: > 25 employees/7-10 Years
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
General Business/Applying Reasoned Judgment/MASTERY
General Business/Demonstrating Business and Industry Acumen/MASTERY
Leadership/Anticipating and Innovating/MASTERY
Leadership/Developing and Executing Strategy/MASTERY
Leadership/Engaging and Developing People/MASTERY
Service/Working Across Boundaries/MASTERY
ADDITIONAL JOB INFORMATION
Extensive exposure to government funded products administration
Fast paced environment and ability to work on multi-faceted initiatives
Professional growth opportunity
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