Strategic Healthcare 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

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.