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We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. The Aetna Better Health of Maryland (ABHMD) Director of Medicaid Regulatory Affairs plays a key role on ABHMD leadership team and the Maryland Department of Health (MDH). The Director of Medicaid Regulatory Affairs serves as the ABHMD Government Liaison. The Director of Regulatory Affairs will work in close partnership with the CEO, ABHMD Executive Leadership Team (ELT) and all matrixed shared service partners to effectively sustain and grow ABHMD membership and ensure the operating efficiency and financial strength of the program. The Director will be the primary senior leader responsible for ongoing program communications and coordination with MDH on behalf of ABHMD. This role is the primary bridge between the health plan and government entities like the Maryland Department of Health, Centers for Medicare & Medicaid Services and, acts as the right hand to the Aetna Better Health of Maryland CEO, while focusing on internal execution and external strategic alignment, while also focusing internally on keeping the Aetna Better Health of Maryland’s operations aligned and running to secure the plan's licensing, navigate policy changes, and maintain the Plan’s MCO contract.
Job Responsibility
Compliance & Policy: Interprets and implements complex Medicaid regulations and ensures the Aetna Better Health of Maryland adheres to them
Government Relations: Serves as the key liaison to state and federal regulators, managing filings, audits, and policy negotiations while supplying regulatory updates to plan leadership on all State and Federal rulemaking and contract communications
Risk Mitigation: Identifies upcoming regulatory shifts and develops organizational strategies to adapt without service interruption
Strategic Planning: Translates the CEO's vision, State and Federal regulatory requirements into actionable, day-to-day goals for the Aetna Better Health of Maryland health plan departments
Cross-Functional Leadership: Coordinates initiatives across different departments (e.g., Clinical, Finance, Provider Relations, and Legal)
Executive Operations: Under the direction of the CEO, manages high-priority projects and acts as an advisor and gatekeeper for the Aetna Better Health of Maryland executive team
State Contract Implementation, Management and Oversight: Develops and manages project plans to implement State contract amendments, fields, and coordinates responses to State inquiries and participates in state meetings, summarizes results and action items
New initiatives and vendor approvals: Prepares all state filings on innovative programs/vendors for State submission and approval
Requirements
7+ years in Medicaid managed care contracting, compliance, or regulatory affairs
Knowledge of Maryland legislative, administrative, and regulatory processes
Experience with relevant stakeholders including the Maryland Department of Health for Medicaid Services and Maryland medical provider community