Medicaid Compliance & Audit Leader

CVS Health Corporation; United States; Remote; 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 leader to drive Medicaid provider compliance, audit readiness, and enterprise risk management. As Manager, Medicaid Provider Compliance, you will shape strategy, lead cross-functional initiatives, and partner with executives to mitigate risks and strengthen regulatory performance across the organization.

The role emphasizes data-driven decision making, strong collaboration with health plans, compliance, and legal teams, and delivering durable,

Qualifications

• 7+ years of healthcare compliance, audit, or provider operations experience.
• Experience leading 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.

Responsibilities

• Translate regulatory requirements into actionable business solutions.
• Lead development and execution of enterprise-wide compliance strategies.
• Serve as SME for provider compliance and audit readiness.
• Build partnerships with regulators, auditors, and health plan stakeholders.
• Develop audit responses and remediation strategies addressing root causes.
• Establish and monitor compliance programs, controls, and governance.
• Present audit outcomes and trends to executive leadership.

Skills

Healthcare compliance

Project leadership

Audit management

Analytical skills

Medicaid knowledge

Communication

Cross-functional coordination

Excel

Data analysis

Regulatory knowledge

Problem solving

Education

Bachelor's degree or equivalent work experience

Master's degree in Healthcare Administration or related field preferred

Job description

CVS Health Corporation is seeking a strategic leader to drive Medicaid provider compliance, audit readiness, and enterprise risk management. As Manager, Medicaid Provider Compliance, you will shape strategy, lead cross-functional initiatives, and partner with executives to mitigate risks and strengthen regulatory performance across the organization.

The role emphasizes data-driven decision making, strong collaboration with health plans, compliance, and legal teams, and delivering durable,