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As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Aetna Better Health of Florida (ABH-FL) is searching for a Senior Manager, Contract Manager and Member Advocate whose duties will be primarily focused on the Florida Healthy Kids contract requirements and regulatory relationship. This colleague will also develop adequate expertise in the Medicaid contract to be back-up for the primary Medicaid contract manager.

This role reports to and works at the direction of the health plan’s Director, Contract Management.

Job Duties

• Oversees all aspects of ABH-FL’s performance in fulfilling the FHK contract requirements.
• Communicates and interfaces with our FHK client and regulator, at the coordinated direction of Director of Contract Management
• Communicates to members (and/or parents/guardians) when required to fulfill regulatory requests or follow up on a complaint or need that is identified by a regulator.
• Advocates for these members until benefits or other issues are resolved.
• Is highly responsive (timely, accurate, pleasant) to the regulator’s requests.
• Keeps ABH-FL leaders promptly notified of FHK personnel changes, policy changes, and other relevant client changes and/or communications.
• Establishes a positive rapport with client; demonstrates helpfulness and partnership to achieve client’s goals.
• Within 30 days, demonstrate an understanding of the varied populations (members) served by a FL Medicaid and FHK managed care plan.
• Demonstrates thorough expertise in the FHK contract and related regulations within 60 days of hire. Demonstrates adequate knowledge of the Medicaid contract within 4 months.
• Provides FHK contract expertise to Plan colleagues and guides their FHK submissions to ensure the FHK request is fully, accurately, and timely met.
• Exercises Quality Control on all communications and regulatory reports delivered to regulators.
• Ensures accurate and timely responses to all regulatory queries and maintains records of all these communications.
• Attends, participates, and assists as needed: Compliance and Policy related Committee activities that are related to the FHK Contract requirements.
• Ensures all FHK/related regulatory personnel (e.g., Q-Source, Maximus, etc.) always see a highly professional face of our company through your work and personal presentation.
• Attend FHK and other similar external meetings in key support role, as needed.
• Lead all project management activities in developing and implementing the appropriate response to Contract requirements and audits.
• As needed, attend regulatory or similar meetings with varied Plan staff (e.g., Compliance, SIU, Quality, Med Management, Operations, Community Development) to support their efforts and promote the highly professional presence of Aetna in these venues.
• The position assumes occasional travel to external stakeholder and regulatory meetings throughout the state.

Required Qualifications

• 3+ years professional experience in health care benefits or a Medicaid-related program position.
• Requires competency in MS Office applications, including Excel and PowerPoint, as well as demonstrable basic experience in project management.
• Interpersonal and relational skills; patience and a customer-first disposition.
• Must be a state of Florida resident.
• A successful background check with fingerprints

Education

• Bachelor’s degree or equivalent work experience

Education Requires a Bachelor’s Degree

Pay Range

The Typical Pay Range For This Role Is

$67,900.00 - $149,328.00

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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great Benefits For Great People

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 04/04/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.