Medicaid Compliance Lead — Senior Manager, Risk & Audits

9025 CVS Shared Services Resources LLC; Southfield (MI); On-site; USD 100,000 - 166,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is seeking a Senior Manager of Medicaid Compliance to oversee the MI Medicaid health plan. You will lead the compliance program, coordinate with state regulators, and guide the team to ensure ethical and compliant operations.

The role requires deep regulatory experience in Medicaid, strong leadership, and collaboration with cross-functional partners to sustain compliant business practices across the health plan.

Qualifications

• 7+ years of regulatory compliance experience in managed care, health care, or insurance.
• 2+ years of project management experience.
• Bachelor’s Degree required or equivalent years of related professional work experience.
• Master’s degree or Juris Doctor preferred.
• Experience with Medicaid or Medicaid managed care preferred.
• Audit experience preferred.

Responsibilities

• Act as primary liaison to the state Medicaid agency for compliance and contract-related communications.
• Maintain systems and tools to track, monitor, and submit regulatory deliverables by due dates.
• Prepare for and manage external audits with state Medicaid and partners.
• Lead and execute all elements of the Medicaid compliance program for the MI plan.
• Develop compliant business operations, processes, and policies per state Medicaid requirements.
• Create compliance communications in response to state Medicaid inquiries.
• Maintain knowledge of contractual, regulatory, and policy obligations for education and decision making.

Skills

Regulatory compliance

Managed care

Project management

Communication

Education

Bachelor’s Degree

Master’s degree or JD

Tools

Archer

Microsoft Office

Job description

CVS Health is seeking a Senior Manager of Medicaid Compliance to oversee the MI Medicaid health plan. You will lead the compliance program, coordinate with state regulators, and guide the team to ensure ethical and compliant operations.

The role requires deep regulatory experience in Medicaid, strong leadership, and collaboration with cross-functional partners to sustain compliant business practices across the health plan.