Medicaid Compliance & Audit Strategy Leader

CVS Pharmacy; Dover (DE); On-site; USD 54,000 - 159,000; Full time

Benefits offered by this job

Comprehensive benefits package

Job summary

CVS Health in the United States seeks a strategic compliance leader to drive Medicaid provider compliance, audit readiness, and enterprise risk management. You will partner with executive leadership and external auditors to identify risks and establish best-in-class audit practices.

The role requires deep regulatory expertise, executive communication, and a track record leading high-impact initiatives that improve data integrity and controls across the organization.

Qualifications

• 7+ years of healthcare compliance, audit, or provider operations experience.
• Experience leading 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.
• Able to drive results across teams with competing priorities.
• Advanced Excel and data analysis proficiency.

Responsibilities

• 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

Project leadership

Audits & CAPs

Analytical skills

Medicaid regulations

Stakeholder influence

Cross-team delivery

Excel & data analysis

Education

Bachelor's degree

Master's degree preferred

Equivalent experience considered

Job description

CVS Health in the United States seeks a strategic compliance leader to drive Medicaid provider compliance, audit readiness, and enterprise risk management. You will partner with executive leadership and external auditors to identify risks and establish best-in-class audit practices.

The role requires deep regulatory expertise, executive communication, and a track record leading high-impact initiatives that improve data integrity and controls across the organization.