Medicaid Compliance Specialist: Drive Regulatory Excellence

CVS Health; Montgomery (AL); On-site; USD 44,000 - 102,000; Full time

Benefits offered by this job

Medical benefits

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a career-level compliance professional to support the compliance program for a Medicaid managed care organization. You will develop systems and processes that promote compliant and ethical behavior across our Medicaid health plans.

Responsibilities include tracking regulatory deliverables, researching compliant operations, and maintaining knowledge of contractual obligations to support decision making. This full-time role offers comprehensive benefits.

Qualifications

• 2+ years of regulatory compliance experience in managed care, healthcare, or insurance.
• Bachelor's degree in a related field required; Master’s considered a plus.

Responsibilities

• Maintain systems to track, monitor, review, and submit regulatory deliverables to state Medicaid agencies.
• Assist with research and recommendations to develop compliant business operations per Medicaid requirements.
• Develop communications for Medicaid agency inquiries or requests.
• Maintain knowledge of contractual, regulatory, and program policy obligations for Medicaid managed care.
• Support external audit reviews with project management of deliverables and corrective action plans.
• Maintain internal tools and contract libraries for compliance oversight.
• Use standard software and compliance tools (e.g., Archer) and train users.
• Elevate risks and issues through appropriate channels with business partners.
• Foster productive relationships to promote ethical and compliant outcomes.

Skills

Regulatory compliance

Medicaid knowledge

Regulatory reporting

Education

Bachelor's Degree

Tools

Archer

Microsoft Office

Job description

CVS Health is seeking a career-level compliance professional to support the compliance program for a Medicaid managed care organization. You will develop systems and processes that promote compliant and ethical behavior across our Medicaid health plans.

Responsibilities include tracking regulatory deliverables, researching compliant operations, and maintaining knowledge of contractual obligations to support decision making. This full-time role offers comprehensive benefits.