Manager, Medicaid Compliance

CVS Health; Phoenix (AZ); On-site; USD 60,000 - 133,000; Full time

Benefits offered by this job

Bonus eligibility

Job summary

CVS Health is seeking a Medicaid Compliance Manager to join our compliance program for Arizona Medicaid plans. You will support the development and maintenance of processes that demonstrate an effective compliance program and promote ethical behavior in our Medicaid health plans.

You will lead tracking of regulatory deliverables, coordinate audits, and advise on policies to ensure adherence to Arizona Medicaid requirements. A strong PM background and experience in managed care are required.

Qualifications

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

Responsibilities

• Maintain systems to track, monitor, and submit regulatory and compliance deliverables to Arizona Medicaid agencies by due dates.
• Develop compliant business operations, processes, and policies per Arizona Medicaid requirements.
• Create compliance communications responding to Arizona Medicaid inquiries for Mercy Care.
• Maintain knowledge of Mercy Care obligations as a Medicaid managed care org; advise staff accordingly.
• Manage external audit reviews with subject matter experts, tracking deliverables and corrective actions.
• Maintain tools, contracts, risk assessments, and internal reporting systems for compliance oversight.
• Utilize systems like Archer; train users and contribute to systems design/maintenance.
• Monitor compliance across the business; help partners mitigate risks and escalate issues.

Skills

Project management

Regulatory compliance

Stakeholder collaboration

Communication

Education

Bachelor’s Degree

Master’s degree preferred

Tools

Archer

Job description

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 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:

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 include, but are not limited to:

• 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 elevate risks, 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

• Other duties as assigned

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

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.

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.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

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

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

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