Senior Manager, Medicaid Compliance - MI

9025 CVS Shared Services Resources LLC; Southfield (MI); On-site; USD 100,000 - 166,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is seeking a Senior Manager of Medicaid Compliance to oversee the MI Medicaid health plan. You will lead the compliance program, coordinate with state regulators, and guide the team to ensure ethical and compliant operations.

The role requires deep regulatory experience in Medicaid, strong leadership, and collaboration with cross-functional partners to sustain compliant business practices across the health plan.

Qualifications

• 7+ years of regulatory compliance experience in managed care, health care, or insurance.
• 2+ years of project management experience.
• Bachelor’s Degree required or equivalent years of related professional work experience.
• Master’s degree or Juris Doctor preferred.
• Experience with Medicaid or Medicaid managed care preferred.
• Audit experience preferred.

Responsibilities

• Act as primary liaison to the state Medicaid agency for compliance and contract-related communications.
• Maintain systems and tools to track, monitor, and submit regulatory deliverables by due dates.
• Prepare for and manage external audits with state Medicaid and partners.
• Lead and execute all elements of the Medicaid compliance program for the MI plan.
• Develop compliant business operations, processes, and policies per state Medicaid requirements.
• Create compliance communications in response to state Medicaid inquiries.
• Maintain knowledge of contractual, regulatory, and policy obligations for education and decision making.

Skills

Regulatory compliance

Managed care

Project management

Communication

Education

Bachelor’s Degree

Master’s degree or JD

Tools

Archer

Microsoft Office

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

As a Senior Manager of Medicaid Compliance, you are responsible for the management, execution, and oversight of the compliance program activities and deliverables of a Medicaid managed care organization operating in a moderately complex regulatory environment. This role will allow you to serve as the designated Compliance Officer for Aetna’s Michigan (MI) Medicaid health plan. You will oversee the activities of other compliance team members assigned to the MI market. You will be responsible for developing and maintaining systems and processes that demonstrate the principles of an effective Compliance program and promote compliant and ethical behavior in the assigned Medicaid health plan.

Responsibilities

• Acts as the primary liaison to the state Medicaid agency, facilitating compliance and contract-related communications and activities
• Maintain the systems and tools to track, monitor, review, and submit required regulatory and compliance related deliverables and responses to state Medicaid agencies on or before required due dates; independently prepares and oversees the submission of complex regulatory reports and deliverables as needed on behalf of the Medicaid compliance team
• Facilitates the preparation for and management of external audits conducted by state Medicaid and related agencies or partners in conjunction with health plan leadership through final report and corrective action plan closure
• Lead and execute all elements of the Medicaid compliance program for Aetna’s MI Medicaid health plan
• Conduct research and develop recommendations to help develop compliant business operations, processes, and policies in accordance with state specific Medicaid program requirements
• Develop compelling, strategic, and appropriate compliance related communications on behalf of the health plan in response to state Medicaid agency inquiries or requests
• Maintain an in-depth working knowledge of the health plan’s contractual, regulatory, and program policy related obligations as a Medicaid managed care organization and serve as a resource to health plan and growth partner staff for education, training, and business decision making purposes
• Ensure that current resource tools and other internal deliverables such as current contract library, regulatory reporting assignments, risk assessments, risk tracking lists, internal reporting systems and summaries, and other department wide tools are current and accessible to business partners to ensure the appropriate monitoring and oversight of health plan compliance processes
• Identify key areas of risk or concern and proactively conduct oversight and monitoring to evaluate levels of compliance with Medicaid managed care organization requirements across the business; support business partners in the development of mitigation and corrective action plans and effectively elevate risks, concerns and other issues through appropriate channels
• Utilize systems unique to job functions, including standard-issue software such as Microsoft products and compliance specific tools such as Archer; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenance
• Lead and direct oversight and monitoring activities to evaluate levels of compliance with new and existing Medicaid managed care organization requirements across the business; support business partners in the development of mitigation and corrective action plans and effectively elevate risks, concerns, and other issues through appropriate channels
• Maintain positive, productive relationships with internal and external senior level constituents to effectively communicate and influence ethical and compliant outcomes
• Provide training and guidance to less experienced team members to accomplish goals
• Other duties as assigned

Required Qualifications

• 7+ years of regulatory compliance experience in managed care, health care, or insurance.
• 2+ years of project management experience.

Preferred Qualifications

• Experience with Medicaid or Medicaid managed care.
• Audit experience.
• Master’s degree or Juris Doctor.

Education

• Bachelor’s Degree required or equivalent years of related professional work experience.

Pay Range

The typical pay range for this role is: $75,400.00 - $165,954.00 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. This position also includes an award target in the company’s equity award program.

Benefits

Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

Application Window

We anticipate the application window for this opening will close on: 10/19/2026

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

Our Culture and Values

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.