Senior Medicaid Provider Compliance Leader

CVS Health Corporation; Oklahoma City (OK); On-site; USD 54,000 - 159,000; Full time

Job summary

CVS Health is seeking a strategic Manager, Medicaid Provider Compliance to lead compliance strategy, audit readiness, and enterprise risk management across the organization. You will serve as a senior SME responsible for shaping initiatives that strengthen regulatory performance and operational excellence.

You will drive cross-functional programs, develop audit responses, monitor KPIs, and mentor analysts while partnering with regulators, auditors, and health plans.

Qualifications

• 7+ years of healthcare compliance, audit, or provider operations experience.
• Experience leading 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.

Responsibilities

• Drive enterprise priorities, manage risk, and translate regulatory requirements into business solutions.
• Develop and execute compliance strategies supporting contractual, regulatory, and business objectives.
• Serve as subject matter expert for provider compliance and audit readiness.
• Use data and compliance expertise to optimize processes and strengthen controls.
• Build partnerships and influence senior leaders across functions.
• Lead enterprise-wide provider compliance, audit preparedness, and regulatory initiatives.
• Develop audit responses and remediation strategies addressing root causes.
• Establish compliance monitoring frameworks and KPIs.
• Drive continuous improvement through process redesign and automation.
• Mentor analysts and compliance professionals to grow capability.

Skills

Analytical thinking

Risk assessment

Problem solving

Communication

Stakeholder influence

Project leadership

Data interpretation

Education

Bachelor's degree or equivalent

Tools

Excel

Job description

CVS Health is seeking a strategic Manager, Medicaid Provider Compliance to lead compliance strategy, audit readiness, and enterprise risk management across the organization. You will serve as a senior SME responsible for shaping initiatives that strengthen regulatory performance and operational excellence.

You will drive cross-functional programs, develop audit responses, monitor KPIs, and mentor analysts while partnering with regulators, auditors, and health plans.