Program Integrity Manager

4004 Aetna Medicaid Administrators; Hartford (CT); Hybrid; USD 66,000 - 146,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Program Integrity Manager to lead Program Integrity, Payment Integrity, and SIU activities. You will ensure compliance with state and federal requirements, support FWA prevention, and coordinate audits and reporting across health plans and vendors.

The role collaborates with senior leadership, compliance, and operations to strengthen oversight, improve performance, and maintain regulatory alignment in a hybrid work environment.

Qualifications

• 5+ years experience in Program Integrity, Payment Integrity, Special Investigations, Healthcare Compliance, Fraud, Waste and Abuse (FWA), Claims Operations, Healthcare Operations, or a related field.
• Knowledge of healthcare regulatory and compliance requirements.
• Strong analytical, organizational, communication, and problem-solving skills.

Responsibilities

• The Program Integrity Manager serves as a key leader supporting Program Integrity, Payment Integrity, and SIU activities.
• This role is responsible for ensuring compliance, coordinating reporting and audit activities, and partnering with internal and external stakeholders to promote operational effectiveness and program integrity.

Skills

Healthcare compliance

Regulatory knowledge

Analytical skills

Communication skills

Cross-functional collaboration

Education

Bachelor's degree or equivalent

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

The Program Integrity Manager serves as a key leader supporting Program Integrity, Payment Integrity, and Special Investigations Unit (SIU) activities. This role is responsible for ensuring compliance with state and federal requirements, supporting fraud, waste, and abuse (FWA) prevention efforts, overseeing regulatory and contractual obligations, coordinating reporting and audit activities, and partnering with internal and external stakeholders to promote operational effectiveness and program integrity. The position works closely with health plan leadership, compliance, SIU, payment integrity vendors, and operational teams to support initiatives that improve performance, strengthen oversight, and ensure compliance with applicable requirements.

Required Qualifications

• 5+ years experience in Program Integrity, Payment Integrity, Special Investigations, Healthcare Compliance, Fraud, Waste and Abuse (FWA), Claims Operations, Healthcare Operations, or a related field.
• Knowledge of healthcare regulatory and compliance requirements.
• Strong analytical, organizational, communication, and problem-solving skills.
• Ability to manage multiple priorities and work effectively in a collaborative environment.
• Experience building relationships and working with cross-functional teams and external stakeholders.

Preferred Qualifications

• Experience supporting Medicaid managed care programs.
• Experience with regulatory reporting, audits, compliance initiatives, or operational oversight activities.
• Experience working with SIU investigations, fraud prevention programs, vendor management, or payment integrity operations.
• Knowledge of healthcare claims, provider reimbursement, payment accuracy, and program integrity practices.

Education

Bachelor's degree or equivalent combination of education and experience.

Hybrid Work Environment

**We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week. Aetna Service Operations office/hub locations will be discussed with the selected candidate.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $66,330.00 - $145,860.00 This pay range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Benefits

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.

• medical
• dental
• vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources, based on eligibility.

Application Deadline

We anticipate the application window for this opening will close on: 09/26/2026.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Our Work Experience

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.