Strategic Medicaid Compliance Leader

CVS Health Corporation; Santa Fe (NM); On-site; USD 54,000 - 159,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Retirement savings options

Paid time off

Job summary

CVS Health Corporation is seeking a strategic Manager, Medicaid Provider Compliance to drive regulatory integrity, audit readiness, and enterprise risk management. You will shape strategy, lead cross-functional initiatives, and influence senior leaders to improve compliance performance across the organization.

The role requires 7+ years in healthcare compliance, strong data analysis skills, and a proven track record in audits, CAPs, and Medicaid regulations.

Qualifications

• 7+ years of healthcare compliance, audit, or provider operations experience.
• Proven ability to lead 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, manages risk, and translates regulatory requirements into business solutions.
• Lead the development and execution of compliance strategies that support contractual, regulatory, and business objectives.
• Serve as a recognized SME for provider compliance and audit readiness, driving initiatives that improve data integrity and internal controls.
• Use data and compliance expertise to optimize processes, strengthen controls, and deliver sustainable results.
• Build trusted partnerships and influence outcomes across functions.
• Lead enterprise-wide provider compliance, audit preparedness, and regulatory initiatives.
• Develop and execute audit response and remediation strategies addressing root causes.
• Influence cross-functional stakeholders and leadership to align priorities and implement solutions.
• Assess emerging regulatory requirements and business risks; develop proactive strategies.
• Lead complex, high-visibility projects with governance and risk management.
• Establish compliance monitoring frameworks, KPIs, and reporting mechanisms.
• Drive continuous improvement through process redesign and automation.
• Provide mentorship to analysts and compliance professionals.
• Maintain relationships with regulators, auditors, health plans, legal, and leadership.
• Present audit outcomes and compliance risks to senior leadership.

Skills

Healthcare compliance

Project leadership

Audits & CAPs

Data analysis

Regulatory knowledge

Stakeholder influence

Excel proficiency

Education

Bachelor's degree or equivalent

Tools

Audit management systems

Job description

CVS Health Corporation is seeking a strategic Manager, Medicaid Provider Compliance to drive regulatory integrity, audit readiness, and enterprise risk management. You will shape strategy, lead cross-functional initiatives, and influence senior leaders to improve compliance performance across the organization.

The role requires 7+ years in healthcare compliance, strong data analysis skills, and a proven track record in audits, CAPs, and Medicaid regulations.