Skip to main content

A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Senior Consultant Medicaid Regulatory Management (59000BR)

Primary Location: Detroit, Michigan
Additional Locations: MI-Detroit
Responsible for compliant benefit contract language development; regulatory submissions, negotiations and approvals; compliance activities as they relate to development and implementation of new language s for Aetna products and programs; and preparat

Fundamental Components:
Understand business expectations and needs, and thoroughly research and incorporate regulatory requirements into filings. Develop, submit and negotiate timely approval of high-quality regulatory filings that comply with state and federal regulatory requirements and meet business expectations and needs. Act as a mentor and provide coaching to staff in preparing timely, complete, high quality filings* Facilitate approvals and expedite resolution of issues pertaining to product, licensing and legislative filings; proactively manage relationships with business clients and regulators by providing timely follow-ups and providing complete and timely regulatory responses; negotiate and resolve business compliance conflicts and product changes to achieve business objectives; and obtain regulatory approvals within aggressive timelines. Coach staff in preparing clear, complete and professional communications to regulators and business areas. Assist staff in effectively articulating Aetna’s positions to regulators. Participate on complex regulatory and business client calls with staff to encourage creative problem solving and coach staff through the negotiation process* Effectively manage multiple filings and projects to ensure that filings and projects reflect P&RA and business priorities and meet/exceed P&RA metrics. Provide early alerts to management when deadlines are in jeopardy. Assist staff with their competing priorities while still meeting your own personal deadlines. Promote a sense of urgency and ownership in resolving regulatory and business issues* Work independently on assignments and assist Team Lead/Senior Managers with mentoring staff through their assigned tasks to ensure that all assignments are completed and delivered on time* Review filings prepared by staff to identify opportunities for quality improvement and increase opportunities for first time filing approval. Assist staff in responding to complex filings* Assist staff with project development to ensure a smooth roll-out to the P&RA team and provide support to the staff in managing their project deliverables* Build, maintain and promote positive and effective working relationships with state/federal regulators and internal clients and insurance groups. Develop best practice processes to foster improved and effective communication* Work closely with attorneys and compliance staff to promote and enforce compliance with state/federal laws and regulations and implementation of risk management policies. Encourage staff to provide early alerts to potential compliance risks* Provide timely updates to product and actuarial teams on the status of projects and keep them apprised of state nuances that impact the product design and pricing* Effectively use P&RA filing and reporting systems* Identify opportunities to streamline processes and improve efficiencies within P&RA and encourage staff to embrace new processes* Adhere to regulatory and internal filing requirements and procedures and mentor staff in completing all end to end workflows* Through example, promote a work environment that encourages staff to seek additional work and take on more challenging assignments* Maintain positive attitude under adverse conditions* Speak up, encourage dialogue among staff, and champion new ideas or processes* Prepare, secure and maintain health plan certifications, licenses and agreements with regulatory agencies* Act with professionalism and demonstrate high personal standards of performance and integrity; complete and promote compliance training and policies; serve as a creditable resource to constituents* Exhibit behaviors outlined in Product & Reg. Affairs Senior Consultant Competencies.

Background Experience:
Strong verbal and written communication skills and the ability to communicate effectively with all levels of management.
5 - 10+ years managed care/ health insurance industry experience.
Self-starter who can work independently and within a team structure.
Strong leadership experience, ability to work independently and adapt to changing priorities, effective management of resources and strong communication skills.
Track record of excellent leadership, time management and teamwork skills.
Track record of meeting project deadlines.
Demonstrated ability to effectively communicate and negotiate across the business at various levels in verbal and written form.
In-depth knowledge of managed care business and/or healthcare environment
Strong problem solving, analytical, and project management skills.
Strong track record of collaborating with multiple and diverse stakeholders.
Positive and proactive attitude is a must.
Adhere to company policies, practices, code of conduct, and applicable laws and regulations
Demonstrated ability to work effectively in a team environment and adapt to changing priorities.
Track record of prioritizing work, multi-tasking, and managing workload efficiently.
Strong technical skills and proficiency in Microsoft Office products (Word, Excel, PowerPoint, Outlook, etc.). Strong work management and service skills. Ability to work effectively in a matrixed environment and navigate throughout the Aetna organization to get things done.
Associate's or Bachelor's degree. Paralegal certificate beneficial.

Potential Telework Position:

Percent of Travel Required:
25 - 50%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

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


Click To Review Our Benefits (PDF)


Jobs for you

Recently Viewed Jobs

You do not have any recently viewed jobs

Your Saved Jobs

You do not have any saved jobs

Sign up for Job Alerts

Join our Talent Community

At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna.

Join Our Talent Community

Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.