Medicaid Provider Compliance Lead

CVS Health; United States; On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources, based on eligibility

Job summary

CVS Health seeks a dynamic leader to drive Medicaid provider compliance, audit excellence, and regulatory integrity across the organization. You will lead strategic initiatives to ensure accurate audit results and strengthen regulatory relationships, while implementing proactive risk mitigation.

The role requires deep expertise in compliance and analytics, with the ability to influence outcomes and standardize processes across teams.

Qualifications

• Progressive audit/compliance/healthcare operations experience (minimum 3 years).
• Ability to develop and execute detailed project plans with accountability.
• Strong analytical skills to interpret data and drive solutions.
• Excel proficiency for data analysis and reporting to strengthen controls.

Responsibilities

• Lead quality internal/external Medicaid provider audits and regulatory deliverables.
• Interpret findings and recommend corrective actions to mitigate risk.
• Support complex inquiries from stakeholders and regulators with accuracy.
• Lead multiple compliance projects and ensure timely execution and outcomes.
• Oversee policy and annual review documentation updates.
• Build partnerships across levels to influence compliant, ethical outcomes.

Skills

Audit leadership

Compliance expertise

Analytical skills

Advanced Excel

Communication

Project leadership

Education

Bachelor’s degree

Tools

Provider data management platforms

Microsoft Excel (advanced)

Job description

CVS Health seeks a dynamic leader to drive Medicaid provider compliance, audit excellence, and regulatory integrity across the organization. You will lead strategic initiatives to ensure accurate audit results and strengthen regulatory relationships, while implementing proactive risk mitigation.

The role requires deep expertise in compliance and analytics, with the ability to influence outcomes and standardize processes across teams.