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Manager, Medicaid Provider Compliance
CVS Health. Drive enterprise priorities, manage risk, and translate regulatory requirements into business solutions .
About the role
Key responsibilities & impact- Drive enterprise priorities, manage risk, and translate regulatory requirements into business solutions
- Lead the development and execution of compliance strategies supporting contractual, regulatory, and business objectives
- Serve as a subject matter expert for provider compliance and audit readiness
- Improve data integrity, strengthen internal controls, standardize processes, and enhance organizational performance
- Lead enterprise-wide provider compliance, audit preparedness, and regulatory initiatives
- Provide strategic guidance on complex provider compliance matters
- Develop and execute audit response and remediation strategies
- Assess emerging regulatory requirements, contractual obligations, and business risks
- Lead complex, high-visibility, cross-functional projects
- Establish compliance monitoring frameworks, KPIs, and reporting mechanisms
- Drive process redesign, automation opportunities, control optimization, and best-practice implementation
- Mentor analysts and compliance professionals
- Maintain relationships with regulators, auditors, health plans, provider relations, legal, compliance, and operational leadership
- Present audit outcomes, compliance risks, trends, and recommendations to senior leadership and executive stakeholders
Requirements
What you’ll need- 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
- Experience with Medicaid provider compliance, provider data management, and healthcare network operations preferred
- Proven success leading audits, compliance programs, and process improvement initiatives preferred
- Experience developing compliance frameworks, controls, and governance programs preferred
- Strong partnership experience with regulators, auditors, and senior leadership preferred
- Knowledge of provider data systems, reporting tools, and compliance monitoring preferred
- Bachelor's degree or equivalent work experience
- Master's degree in Healthcare Administration, Business Administration, Public Health, Compliance, or related field preferred
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being