Manager, Medicaid Provider Compliance

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

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation is seeking a strategic Manager, Medicaid Provider Compliance to drive regulatory integrity and enterprise risk management. You will partner with executive leadership to identify compliance risks, develop mitigation strategies, and lead cross‑functional initiatives for audit readiness.

You will serve as SME for provider compliance, oversee audits, CAPs, and regulatory responses, and build monitoring frameworks with KPIs.

Qualifications

• 7+ years of healthcare compliance, audit, or provider operations experience.
• 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.
• Advanced Excel and data analysis proficiency.

Responsibilities

• Drive enterprise priorities, manages risk, and translates regulatory requirements into business solutions.
• Lead 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.
• Serve 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.

Skills

Healthcare compliance

Audit

Provider operations

Analytical skills

Data analysis

Excel

Education

Bachelor's degree

Tools

Excel

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

$54,300.00 - $159,120.00

The Typical Pay Range For This Role Is

$54,300.00 - $159,120.00

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: 10/17/2026

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