Medicaid Provider Compliance Lead - Audit & Risk

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

Benefits offered by this job

Bonus potential

Comprehensive benefits

Paid time off

Retirement savings plan

Job summary

CVS Health Corporation seeks a strategic Manager, Medicaid Provider Compliance to drive enterprise-wide provider compliance and audit readiness. You will partner with executives, health plans, legal, and operations to proactively identify risks, shape strategy, and implement sustainable compliance programs.

The role requires leading complex initiatives, developing remediation plans, monitoring performance with KPIs, and mentoring analysts, while fostering strong relationships with regulators and

Qualifications

• 7+ years in healthcare compliance, audit, or provider operations.
• Proven ability to lead complex compliance initiatives and audits.
• Experience implementing corrective actions and remediation plans.
• 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 cross-functional results and manage competing priorities.
• Advanced Excel and data analysis proficiency.

Responsibilities

• Drive enterprise priorities, manages risk, and translates regulatory requirements into business solutions.
• Lead development and execution of compliance strategies aligning with contractual, regulatory, and business objectives.
• Serve as subject matter expert for provider compliance and audit readiness; improve data integrity and internal controls.
• Use data and compliance expertise to optimize processes and deliver sustainable results.
• Build partnerships with senior leaders; influence outcomes across functions.
• Lead enterprise-wide provider compliance, audit preparedness, and regulatory initiatives.
• Provide strategic guidance to leadership and business partners on complex compliance matters.
• Develop and execute audit response and remediation strategies addressing root causes.
• Influence cross-functional stakeholders to align priorities and implement effective solutions.
• Assess emerging regulatory requirements and business risks; develop proactive compliance strategies.
• Lead cross-departmental projects with governance, accountability, and risk management.
• Establish monitoring frameworks, KPIs, and reporting to measure compliance performance.
• Drive continuous improvement through process redesign and automation.
• Mentor analysts and compliance professionals to build organizational capability.
• Build relationships with regulators, auditors, health plans, and legal/compliance leadership.
• Present audit outcomes, risks, trends, and recommendations to senior leadership.

Skills

Healthcare compliance

Audit leadership

Regulatory risk management

Stakeholder influence

Advanced Excel

Education

Bachelor's degree

Job description

CVS Health Corporation seeks a strategic Manager, Medicaid Provider Compliance to drive enterprise-wide provider compliance and audit readiness. You will partner with executives, health plans, legal, and operations to proactively identify risks, shape strategy, and implement sustainable compliance programs.

The role requires leading complex initiatives, developing remediation plans, monitoring performance with KPIs, and mentoring analysts, while fostering strong relationships with regulators and