Medicaid Provider Compliance Lead - Audit Readiness

CVS Health Corporation; Montpelier (VT); On-site; USD 54,000 - 159,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Paid time off

Job summary

CVS Health Corporation is seeking a strategic Manager, Medicaid Provider Compliance to drive regulatory integrity and enterprise risk management. You will partner with executive leadership and external auditors to identify risks, shape strategy, and implement sustainable compliance practices.

The role spans cross-functional collaboration, data-driven process improvements, and leadership of complex audits and CAPs.

Qualifications

• 7+ years of healthcare compliance, audit, or provider operations experience.
• Proven ability to lead complex projects and compliance initiatives.
• Experience managing audits, CAPs, 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.
• Ability to drive results across teams and manage competing priorities.
• Advanced Excel and data analysis proficiency.

Responsibilities

• Drive enterprise priorities, manages risk, and translates regulatory requirements into business solutions.
• Leads the development and execution of compliance strategies that support contractual, regulatory, and business objectives while promoting accountability and continuous improvement.
• Serves as a subject matter expert for provider compliance and audit readiness, driving initiatives to improve data integrity and internal controls.
• Use data and compliance expertise to optimize processes, strengthen controls, and deliver sustainable results.
• Build trusted partnerships, communicates effectively with senior leaders, and influences outcomes across functions.
• Lead enterprise-wide provider compliance, audit preparedness, and regulatory initiatives that support objectives and reduce risk.
• Develop and execute audit response and remediation strategies addressing root causes and improving controls.

Skills

Healthcare compliance

Audit leadership

Regulatory analysis

Stakeholder influence

Excel & data analysis

Risk management

Project management

Education

Bachelor's degree or equivalent

Tools

Excel

Job description

CVS Health Corporation is seeking a strategic Manager, Medicaid Provider Compliance to drive regulatory integrity and enterprise risk management. You will partner with executive leadership and external auditors to identify risks, shape strategy, and implement sustainable compliance practices.

The role spans cross-functional collaboration, data-driven process improvements, and leadership of complex audits and CAPs.