Medicaid Compliance Lead — Audit & Regulatory Strategy

CVS Health; Kentucky; Hybrid; USD 75,000 - 166,000; Full time

Benefits offered by this job

Bonus eligibility

Equity awards

Comprehensive benefits

Job summary

CVS Health is seeking a Senior Manager of Medicaid Compliance to lead the compliance program for the Ohio Medicaid health plan, directing the team and ensuring timely regulatory deliverables.

You will act as liaison to state Medicaid agencies, oversee audits and corrective actions, and develop policies that align with state requirements while promoting ethical and compliant operations across the health plan.

Qualifications

• 7+ years of regulatory compliance experience in managed care, health care, or insurance.
• 2+ years of project management experience.
• Experience with Medicaid or Medicaid managed care is preferred.
• Audit experience is a plus.
• Bachelor's Degree in Public Policy, Government Affairs, Health Care Administration, or Public Administration; required or equivalent years of related professional work experience.

Responsibilities

• Act as the primary liaison to the state Medicaid agency and oversee communications and activities.
• Maintain systems to track, monitor, review, and submit regulatory deliverables to state Medicaid agencies.
• Facilitate external audits and oversee corrective action plans with health plan leadership.
• Lead and execute all elements of the Medicaid compliance program for the OH Medicaid health plan.
• Develop compliant business operations, processes, and policies per state requirements.
• Provide training and guidance to team members and educate partners on compliance matters.

Skills

Regulatory compliance

Project management

Medicaid knowledge

Audit experience

Policy development

Education

Bachelor's degree in Public Policy/Health Admin

Master's degree or JD (preferred)

Tools

Archer

Microsoft Office

Job description

CVS Health is seeking a Senior Manager of Medicaid Compliance to lead the compliance program for the Ohio Medicaid health plan, directing the team and ensuring timely regulatory deliverables.

You will act as liaison to state Medicaid agencies, oversee audits and corrective actions, and develop policies that align with state requirements while promoting ethical and compliant operations across the health plan.