Medicaid Compliance Specialist

CVS Health; Carson City (NV); On-site; USD 44,000 - 102,000; Full time

Job summary

CVS Health is seeking a career-level compliance professional to support the compliance program activities for a Medicaid managed care organization. You will help develop and maintain systems and processes that demonstrate the principles of an effective Compliance program and promote ethical behavior across the health plan.

Responsibilities include tracking regulatory deliverables, researching compliant operations, and drafting communications for Medicaid inquiries.

Qualifications

• 2+ years of regulatory compliance experience in managed care, healthcare, or insurance; or a Master’s degree.
• Bachelor’s Degree required; Master’s preferred as alternative.
• Proficiency with compliance tools (e.g., Archer) and regulatory guidance documentation.

Responsibilities

• Maintain systems to track, monitor, review, and submit regulatory deliverables to state Medicaid agencies on or before due dates.
• Assist with research and recommendations to develop compliant business operations and policies.
• Develop clear compliance communications in response to Medicaid inquiries.
• Maintain knowledge of contractual, regulatory, and program policy obligations for Medicaid managed care.
• Support external audit reviews and manage deliverables, responses, and corrective action plans.
• Maintain internal tools and resources (contract library, risk assessments, reporting) for oversight of compliance processes.

Skills

Regulatory compliance

Healthcare compliance

Education

Bachelor’s Degree

Master’s Degree

Tools

Archer

Job description

CVS Health is seeking a career-level compliance professional to support the compliance program activities for a Medicaid managed care organization. You will help develop and maintain systems and processes that demonstrate the principles of an effective Compliance program and promote ethical behavior across the health plan.

Responsibilities include tracking regulatory deliverables, researching compliant operations, and drafting communications for Medicaid inquiries.