Medicaid Provider Compliance Lead — Audit & Risk

4004 Aetna Medicaid Administrators; United States; On-site; USD 54,000 - 159,000; Full time

Job summary

CVS Health is seeking a strategic Manager, Medicaid Provider Compliance to lead compliance strategy, audits readiness, risk management, and enterprise regulatory integrity. The role partners with senior leaders to drive cross‑functional initiatives and strengthen internal controls across the organization.

Requirements include 7+ years in healthcare compliance and advanced Excel/data analysis. This is a full‑time, US-based position offering comprehensive benefits and a focus on continuous

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 a culture of accountability, continuous improvement, and risk awareness.
• Serves as a recognized subject matter expert for provider compliance and audit readiness, driving initiatives that improve data integrity, strengthen internal controls, standardize processes, and enhance organizational performance
• 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 organizational objectives and reduce compliance risk.
• Serve as the primary subject matter expert for complex provider compliance matters, providing strategic guidance to leadership and business partners.
• Develop and execute audit response and remediation strategies that address root causes, improve controls, and drive long-term compliance improvements.
• Influence cross-functional stakeholders and senior leadership to align priorities, resolve challenges, and implement effective compliance solutions.
• Assess emerging regulatory requirements, contractual obligations, and business risks; develop proactive strategies to ensure compliance and operational readiness.
• Lead complex, high-visibility projects spanning multiple departments, ensuring effective governance, accountability, risk management, and successful execution.
• Establish and maintain compliance monitoring frameworks, key performance indicators, and reporting mechanisms to measure compliance effectiveness and identify opportunities for improvement.
• Drive continuous improvement efforts through process redesign, automation opportunities, control optimization, and best practice implementation.
• Provide mentorship, guidance, and technical leadership to analysts and compliance professionals, fostering organizational capability and knowledge development.
• Build and maintain strong working relationships with regulators, auditors, health plans, provider relations teams, legal, compliance, and operational leadership.
• Present audit outcomes, compliance risks, trends, and recommendations to senior leadership and executive stakeholders.

Skills

Healthcare compliance

Audit management

Provider operations

Regulatory knowledge

Analytical skills

Stakeholder influence

Excel/Data analysis

Education

Bachelor's degree

Tools

Excel

Job description

CVS Health is seeking a strategic Manager, Medicaid Provider Compliance to lead compliance strategy, audits readiness, risk management, and enterprise regulatory integrity. The role partners with senior leaders to drive cross‑functional initiatives and strengthen internal controls across the organization.

Requirements include 7+ years in healthcare compliance and advanced Excel/data analysis. This is a full‑time, US-based position offering comprehensive benefits and a focus on continuous