Manager, Medicaid Provider Compliance

CVS Health Corporation; Augusta (ME); On-site; USD 54,000 - 159,000; Full time

Benefits offered by this job

Bonus potential

Comprehensive benefits

Paid time off

Retirement savings plan

Job summary

CVS Health Corporation seeks a strategic Manager, Medicaid Provider Compliance to drive enterprise-wide provider compliance and audit readiness. You will partner with executives, health plans, legal, and operations to proactively identify risks, shape strategy, and implement sustainable compliance programs.

The role requires leading complex initiatives, developing remediation plans, monitoring performance with KPIs, and mentoring analysts, while fostering strong relationships with regulators and

Qualifications

• 7+ years in healthcare compliance, audit, or provider operations.
• Proven ability to lead complex compliance initiatives and audits.
• Experience implementing corrective actions and remediation plans.
• 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 cross-functional results and manage competing priorities.
• Advanced Excel and data analysis proficiency.

Responsibilities

• Drive enterprise priorities, manages risk, and translates regulatory requirements into business solutions.
• Lead development and execution of compliance strategies aligning with contractual, regulatory, and business objectives.
• Serve as subject matter expert for provider compliance and audit readiness; improve data integrity and internal controls.
• Use data and compliance expertise to optimize processes and deliver sustainable results.
• Build partnerships with senior leaders; influence outcomes across functions.
• Lead enterprise-wide provider compliance, audit preparedness, and regulatory initiatives.
• Provide strategic guidance to leadership and business partners on complex compliance matters.
• Develop and execute audit response and remediation strategies addressing root causes.
• Influence cross-functional stakeholders to align priorities and implement effective solutions.
• Assess emerging regulatory requirements and business risks; develop proactive compliance strategies.
• Lead cross-departmental projects with governance, accountability, and risk management.
• Establish monitoring frameworks, KPIs, and reporting to measure compliance performance.
• Drive continuous improvement through process redesign and automation.
• Mentor analysts and compliance professionals to build organizational capability.
• Build relationships with regulators, auditors, health plans, and legal/compliance leadership.
• Present audit outcomes, risks, trends, and recommendations to senior leadership.

Skills

Healthcare compliance

Audit leadership

Regulatory risk management

Stakeholder influence

Advanced Excel

Education

Bachelor's degree

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 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

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

• Master's degree in Healthcare Administration, Business Administration, Public Health, Compliance, or related field preferred.

Education

• Bachelor's degree or equivalent work experience

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $159,120.00

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 (https://learn.bswift.com/cvshealth-mainland) .

We anticipate the application window for this opening will close on: 10/17/2026

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

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.