Medicaid Provider Compliance Leader – Audit & Risk

CVS Health; Trenton (NJ); On-site; USD 47,000 - 112,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits

Paid time off

Job summary

CVS Health is seeking a dynamic leader to drive Medicaid provider compliance, audit excellence, and regulatory integrity across our organization. You will lead strategic initiatives to ensure accurate, timely audit results and strengthen regulatory relationships.

You will partner cross-functionally to optimize audit outcomes, mitigate risk, and implement preventative measures while guiding best practices that enhance efficiency and compliance.

Qualifications

• Minimum of 3 years of progressive experience in audit, compliance, or related healthcare operations.
• Proven ability to develop and execute detailed project plans with accountability and rigor to deliver complex initiatives successfully.
• Strong analytical skills with demonstrated ability to interpret data, identify trends, and recommend actionable solutions for compliance-related challenges.
• Experience with Microsoft Excel with advanced proficiency for data analysis and reporting to strengthen internal controls and mitigate risk.
• Exceptional ability to convey complex information clearly and concisely, build relationships across organizational levels, and influence decision-making.
• Ability to lead initiatives, mentor team members, and thrive in a fast-paced, evolving environment while maintaining compliance and quality standards.

Responsibilities

• Direct and foster best-in-class collaboration with internal teams and external auditors to deliver quality results, ensure continuous improvement, and maintain compliance.
• Interpret audit findings to recommend sustainable corrective actions and process improvements that mitigate risk.
• Support the response to complex inquiries from internal stakeholders and regulators with accuracy, timeliness, and completeness.
• Serve as a technical and functional leader, managing multiple compliance-related projects and deliverables to ensure timely execution and desired outcomes.
• Oversee policy and procedural documentation development and the timeliness of required annual reviews.
• Build and sustain productive partnerships across all organizational levels; exercise sound judgment, remove barriers, and influence ethical, compliant outcomes to achieve strategic goals.

Skills

Audit & compliance

Project planning

Data analysis

Communication

Leadership

Regulatory knowledge

Education

Bachelor's degree

Tools

Excel

Provider data platforms

Regulatory reporting tools

Job description

CVS Health is seeking a dynamic leader to drive Medicaid provider compliance, audit excellence, and regulatory integrity across our organization. You will lead strategic initiatives to ensure accurate, timely audit results and strengthen regulatory relationships.

You will partner cross-functionally to optimize audit outcomes, mitigate risk, and implement preventative measures while guiding best practices that enhance efficiency and compliance.