Manager, Medicaid Provider Compliance

Were building a world of health around every individual shaping a more connected convenient and compassionate health experience. At CVS Health youll be surrounded by passionate colleagues who care deeply innovate with purpose hold ourselvesaccountable 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.

Position Summary

We are seeking a strategic compliance leader to drive Medicaid provider compliance audit readiness regulatory integrity and enterprise risk management across the organization. As the Manager Medicaid Provider Compliance you will serve as a senior subject matter expert responsible for shaping compliance strategy leading complex cross-functional initiatives influencing business decisions and advancing sustainable solutions that strengthen regulatory performance and operational excellence.

The successful candidate will partner with executive leadership health plan stakeholders compliance legal provider operations and external auditors to proactively identify compliance risks develop enterprise-wide mitigation strategies and establish best-in-class audit and compliance practices.

Key Responsibilities

• Drive enterprise priorities manages risk and translates regulatory requirements into business solutions.
• Leads the development and execution of compliance strategies that support contractual regulatory and business objectives while promoting a culture of accountability continuous improvement and risk awareness.
• Serves as a recognized subject matter expert for provider compliance and audit readiness driving initiatives that improve data integrity strengthen internal controls standardize processes and enhance organizational performance
• Use data and compliance expertise to optimize processes strengthen controls and deliver sustainable results.
• Build trusted partnerships communicates effectively with senior leaders and influences outcomes across functions.
• Lead enterprise-wide provider compliance audit preparedness and regulatory initiatives that support organizational objectives and reduce compliance risk.
• Serve as the primary subject matter expert for complex provider compliance matters providing strategic guidance to leadership and business partners.
• Develop and execute audit response and remediation strategies that address root causes improve controls and drive long-term compliance improvements.
• Influence cross-functional stakeholders and senior leadership to align priorities resolve challenges and implement effective compliance solutions.
• Assess emerging regulatory requirements contractual obligations and business risks; develop proactive strategies to ensure compliance and operational readiness.
• Lead complex high-visibility projects spanning multiple departments ensuring effective governance accountability risk management and successful execution.
• Establish and maintain compliance monitoring frameworks key performance indicators and reporting mechanisms to measure compliance effectiveness and identify opportunities for improvement.
• Drive continuous improvement efforts through process redesign automation opportunities control optimization and best practice implementation.
• Provide mentorship guidance and technical leadership to analysts and compliance professionals fostering organizational capability and knowledge development.
• Build and maintain strong working relationships with regulators auditors health plans provider relations teams legal compliance and operational leadership.
• Present audit outcomes compliance risks trends and recommendations to senior leadership and executive stakeholders.

Required Qualifications

• 7 years of healthcare compliance audit or provider operations experience
• Proven ability to lead complex projects and compliance initiatives
• Experience managing audits CAPs and regulatory responses
• Strong analytical risk assessment and problem-solving skills
• Knowledge of Medicaid regulations and provider compliance requirements
• Excellent communication and stakeholder influence skills
• Ability to drive results across teams and manage competing priorities
• Advanced Excel and data analysis proficiency

Preferred Qualifications

• Experience with Medicaid provider compliance provider data management and healthcare network operations
• Proven success leading audits compliance programs and process improvement initiatives
• Experience developing compliance frameworks controls and governance programs
• Strong partnership experience with regulators auditors and senior leadership
• Knowledge of provider data systems reporting tools and compliance monitoring
• Masters degree in Healthcare Administration Business Administration Public Health Compliance or related field preferred.

Education

• Bachelors degree or equivalent work experience

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

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