Medicaid Provider Compliance Leader

CVS Health Corporation; Frankfort (KY); Vor Ort; USD 54.000 - 159.000; Vollzeit

Zusammenfassung

CVS Health Corporation seeks a strategic Manager, Medicaid Provider Compliance to lead compliance strategy and enterprise risk management across the organization. You will serve as a senior SME responsible for shaping initiatives, influencing business decisions, and advancing sustainable solutions that strengthen regulatory performance.

The role requires deep knowledge of Medicaid regulations, audit readiness, and cross-functional collaboration with regulators, health plans, and operations to

Qualifikationen

• 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.

Aufgaben

• 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.

Kenntnisse

Analytical thinking

Risk assessment

Problem-solving

Communication skills

Stakeholder management

Advanced Excel

Medicaid regulations

Data analysis

Ausbildung

Bachelor's degree

Master's degree preferred

Jobbeschreibung

CVS Health Corporation seeks a strategic Manager, Medicaid Provider Compliance to lead compliance strategy and enterprise risk management across the organization. You will serve as a senior SME responsible for shaping initiatives, influencing business decisions, and advancing sustainable solutions that strengthen regulatory performance.

The role requires deep knowledge of Medicaid regulations, audit readiness, and cross-functional collaboration with regulators, health plans, and operations to