Senior Manager, Medicare Compliance & Audit Readiness

CVS Health; Cheyenne (WY); On-site; USD 68,000 - 199,000; Full time

Benefits offered by this job

Bonus opportunities

Equity award program

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Diversity and inclusion commitment

Job summary

CVS Health is seeking a Sr, Manager, Business Compliance to lead Medicare Part C/ Fast Track Appeals regulatory alignment and responses to CMS inquiries. The role partners with Legal, Quality & Audit, and Compliance teams to ensure auditable, compliant processes and timely regulatory deliverables across the organization.

We expect experience with CMS regulations, strong communication, and the ability to manage complex risks across multiple stakeholders.

Qualifications

• 7+ years Medicare experience related to the duties and responsibilities specified.
• 7+ years of CMS audit, Medicare compliance or service operations experience.
• Ability to understand complex problems and collaborate with business leaders to plan, solve, and execute solutions.
• Experience working directly with CMS or other regulatory entities.

Responsibilities

• Monitor and interpret new and evolving regulatory requirements and standards, ensuring the organization's processes and practices remain compliant.
• Function as a liaison with CMS representatives, external contractors, legal counsel, and internal teams to ensure alignment on regulatory and operational issues.
• Develop and maintain compliance oversight protocols, ensuring adherence to expedited timelines and regulatory expectations.
• Identify operational and compliance gaps and develop and implement mitigation plans.
• Collaborate with business leaders to ensure departmental policies and workflows are compliant and reflect current regulatory requirements.
• Partner with Quality and Audit teams to prepare for and respond to CMS and an active participate in all internal, NCQA, internal and departmental mock audits.
• Compliance reporting tools to track performance, identify trends, and elevate risks to ELT and key business partners such as Medicare Operations Integrity and Medicare Compliance.
• Create and manage a long‑term operational strategy to manage appeals, and audit responses.
• Establish and lead cross‑functional workgroups to address compliance risks, implement new regulatory requirements, drive continuous improvement, and participate.
• Monitor ongoing compliance across business units, conduct risk assessments, and assist with audits.
• Drive the planning and execution of projects related to compliance and regulatory requirements.

Skills

Medicare experience

CMS audit

Regulatory liaison

Education

Associate’s degree or equivalent work experience

Job description

CVS Health is seeking a Sr, Manager, Business Compliance to lead Medicare Part C/ Fast Track Appeals regulatory alignment and responses to CMS inquiries. The role partners with Legal, Quality & Audit, and Compliance teams to ensure auditable, compliant processes and timely regulatory deliverables across the organization.

We expect experience with CMS regulations, strong communication, and the ability to manage complex risks across multiple stakeholders.