Medicaid Program Integrity Lead

CVS Health; Austin (TX); Hybrid; USD 60,000 - 133,000; Full time

Benefits offered by this job

Comprehensive benefits package

Hybrid work environment

Hybrid/ onsite flexibility

Job summary

CVS Health in Austin, TX is seeking a Program Integrity Manager to lead Medicaid Program Integrity, Payment Integrity, and SIU activities. You will ensure compliance with state and federal requirements and coordinate reporting with internal and external stakeholders.

The role requires 5+ years in program integrity or related fields, strong analytical and communication skills, and the ability to manage multiple priorities in a collaborative environment.

Qualifications

• 5+ years experience in Program Integrity, Payment Integrity, Special Investigations, Healthcare Compliance, Fraud, Waste and Abuse (FWA), Claims Operations, Healthcare Operations, or a related field.
• Knowledge of healthcare regulatory and compliance requirements.
• Strong analytical, organizational, communication, and problem-solving skills.
• Ability to manage multiple priorities and work effectively in a collaborative environment.
• Experience building relationships and working with cross-functional teams and external stakeholders.

Responsibilities

• Ensure compliance with state and federal requirements for Medicaid Program Integrity, Payment Integrity, and SIU activities.
• Support fraud, waste, and abuse (FWA) prevention efforts and oversee regulatory and contractual obligations.
• Coordinate reporting and audit activities; partner with internal and external stakeholders to promote operational effectiveness and program integrity.
• Work closely with health plan leadership, compliance, SIU, payment integrity vendors, and operational teams to support initiatives.

Skills

Program Integrity

Healthcare compliance

Analytical skills

Communication skills

Cross-functional collaboration

Stakeholder management

Education

Bachelor's degree

Job description

CVS Health in Austin, TX is seeking a Program Integrity Manager to lead Medicaid Program Integrity, Payment Integrity, and SIU activities. You will ensure compliance with state and federal requirements and coordinate reporting with internal and external stakeholders.

The role requires 5+ years in program integrity or related fields, strong analytical and communication skills, and the ability to manage multiple priorities in a collaborative environment.