Medicaid Provider Compliance Lead & Audit Strategy

CVS Health Corporation

Springfield (IL)

On-site

USD 54,000 - 159,000

Full time

3 days ago

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Job summary

CVS Health Corporation is seeking a strategic Manager, Medicaid Provider Compliance to lead Medicaid provider compliance, audit readiness, and enterprise risk management across the organization. You will shape strategy, oversee cross-functional initiatives, and partner with regulators and senior leaders to strengthen performance.

The role requires 7+ years in healthcare compliance, strong analytical skills, and experience managing audits.

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.

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 subject matter expert for provider compliance and audit readiness, driving initiatives that improve data integrity, strengthen internal controls, standardize processes, and enhance organizational performance.
Build trusted partnerships and influence outcomes across functions.
Lead enterprise-wide provider compliance, audit preparedness, and regulatory initiatives that support organizational objectives and reduce compliance risk.