Manager, Medicaid Compliance

9025 CVS Shared Services Resources LLC; Phoenix (AZ); On-site; USD 60,000 - 133,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources, based on eligibility

Job summary

CVS Health is seeking a Medicaid Compliance Manager to support the compliance program activities within a Medicaid managed care environment. You will partner with and report to the Compliance Officer to develop systems that promote ethical behavior and regulatory adherence across Mercy Care’s Medicaid plans.

The role requires 5+ years of regulatory compliance in health care/managed care, with knowledge of Medicaid requirements; a Bachelor's degree is required, and a Master’s or JD is preferred.

Qualifications

• Minimum of 5 years of regulatory compliance position in managed care, health care, or insurance.
• Experience with Medicaid or Medicaid managed care; audit coordination and policy management preferred.
• Bachelor’s Degree preferably in Public Policy, Government Affairs, Health Care Administration, or Public Administration; Masters degree or Juris Doctor preferred.

Responsibilities

• Maintain systems and tools to track, monitor, review, and submit required regulatory and compliance deliverables to Arizona Medicaid agencies on/before due dates.
• Prepare moderately complex regulatory reports for the Medicaid compliance team.
• Develop compliant business processes and policies per Arizona Medicaid requirements.
• Create compliance communications for Mercy Care in response to Arizona Medicaid inquiries.
• Maintain knowledge of Mercy Care obligations as a Medicaid managed care organization and advise staff.

Education

Bachelor’s Degree in Public Policy / Government Affairs / Health Care Administration

Masters or Juris Doctor preferred

Tools

Archer

Microsoft Office

Job description

Company Overview

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.

Position Summary

As a Medicaid Compliance Manager, you are in an experienced/career level compliance position that supports the compliance program activities and deliverables of a Medicaid managed care organization. In partnership with and under the direction of the health plan Compliance Officer, this position will help develop and maintain systems and processes that demonstrate the principles of an effective Compliance program and promote compliant and ethical behavior in our Medicaid health plans.

Responsibilities

• Maintain the systems and tools to track, monitor, review, and submit required regulatory and compliance related deliverables and responses to Arizona Medicaid agencies on or before required due dates;
• prepares moderately complex regulatory reports as needed on behalf of the Medicaid compliance team;
• Conduct research and develop recommendations to help develop compliant business operations, processes and policies in accordance with Arizona specific Medicaid program requirements;
• Develop compelling and appropriate compliance related communications on behalf of Mercy Care in response to Arizona Medicaid agency inquiries or requests;
• Maintain an in-depth working knowledge of the Mercy Care’s contractual, regulatory, and program policy related obligations as a Medicaid managed care organization and serve as a resource to Mercy Care and Medicaid growth partner staff for education and business decision making purposes;
• Manage and support the external audit review process in conjunction with designated subject matter experts at Mercy Care, including, but not limited to the project management and tracking of required deliverables, responses, and corrective action plan development (through closure);
• Maintain current resource tools and other internal deliverables such as current contract library, regulatory reporting assignments, risk assessments, risk tracking lists, internal reporting systems and summaries, and other department wide tools as needed to ensure the appropriate monitoring and oversight of Mercy Care and Medicaid compliance processes;
• Utilize systems unique to job functions, including standard-issue software such as Microsoft products and compliance specific tools such as Archer; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenance;
• Conduct oversight and monitoring to evaluate levels of compliance with Mercy Care requirements across the business; support business partners in the development of mitigation and corrective action plans and effectively escalates risk, concerns and other issues through appropriate channels;
• Maintain positive, productive relationships with internal and external constituents to effectively communicate and influence ethical and compliant outcomes;
• Provide training and guidance to less experienced team members to accomplish goals.

Required Qualifications

Minimum of 5 years of regulatory compliance position in managed care, health care, or insurance Project management experience.

Preferred Qualifications

Experience with Medicaid or Medicaid managed care. Experience with audit coordination and policy management.

Education

Bachelor’s Degree preferably in Public Policy, Government Affairs, Health Care Administration, or Public Administration; equivalent years of relevant work experience may substitute. Masters degree or Juris Doctor preferred.

Working Hours & Pay

Anticipated Weekly Hours 40 Time Type Full time. Pay Range: The typical pay range for this role is: $60,300.00 - $132,600.00. 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.

Benefits

• medical coverage
• dental coverage
• vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources, based on eligibility

Application Deadline

We anticipate the application window for this opening will close on: 10/10/2026.

Equal Opportunity Statement

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

Work Culture

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. We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This comprehensive benefits package includes medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it’s our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.