Medicaid Provider Compliance Lead

Colorado Psychiatric; Denver (CO); Hybrid; USD 54,000 - 159,000; Full time

Job summary

CVS Health is seeking a strategic leader to drive Medicaid provider compliance, audit readiness, and enterprise risk management. As the Manager, Medicaid Provider Compliance, you will guide strategy, lead cross-functional initiatives, and influence business decisions to strengthen regulatory performance and operational excellence.

You will serve as the SME for provider compliance, shaping remediation strategies, improving controls, and partnering with regulators, auditors, and health plans to

Qualifications

• 7+ years of healthcare compliance, audit, or provider operations experience.
• Experience leading audits and regulatory responses.
• Strong analytical, risk assessment, and problem-solving skills.
• Knowledge of Medicaid regulations and provider compliance requirements.
• Excellent communication and stakeholder influence skills.
• Advanced Excel and data analysis proficiency.

Responsibilities

• Drive enterprise priorities, manage risk, and translate regulatory requirements into business solutions.
• Lead development and execution of compliance strategies that support contractual, regulatory, and business objectives.
• Serve as a subject matter expert for provider compliance and audit readiness, driving data-driven improvements.
• Use data and compliance expertise to optimize processes, strengthen controls, and deliver sustainable results.
• Build trusted partnerships, communicate with senior leaders, and influence outcomes across functions.
• Lead enterprise-wide provider compliance, audit preparedness, and regulatory initiatives.
• Develop audit response and remediation strategies addressing root causes and long-term improvements.

Skills

Healthcare compliance

Audit & CAPs

Regulatory risk management

Data analysis

Medicaid knowledge

Stakeholder influence

Excel proficiency

Education

Bachelor's degree

Job description

CVS Health is seeking a strategic leader to drive Medicaid provider compliance, audit readiness, and enterprise risk management. As the Manager, Medicaid Provider Compliance, you will guide strategy, lead cross-functional initiatives, and influence business decisions to strengthen regulatory performance and operational excellence.

You will serve as the SME for provider compliance, shaping remediation strategies, improving controls, and partnering with regulators, auditors, and health plans to