Strategic Medicaid Provider Compliance Lead

CVS Health Corporation; Providence (RI); On-site; USD 54,000 - 159,000; Full time

Job summary

CVS Health Corporation seeks a strategic Manager, Medicaid Provider Compliance to shape compliance strategy and lead cross-functional initiatives across the organization. You will serve as a senior SME responsible for regulatory integrity and sustainable improvements that strengthen performance.

You will drive audit readiness, leverage data to optimize controls, and partner with senior leaders to reduce compliance risk while advancing operational excellence.

Qualifications

• 7+ years of healthcare compliance, audit, or provider operations experience.
• 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.
• Advanced Excel and data analysis proficiency.

Responsibilities

• Drive enterprise priorities, manage risk, and translate regulatory requirements into solutions.
• Lead development and execution of strategies supporting regulatory objectives.
• Serve as SME for provider compliance and audit readiness.
• Use data to optimize processes, strengthen controls, and deliver results.
• Build partnerships with senior leaders and influence outcomes across functions.
• Lead enterprise-wide provider compliance and audit initiatives.
• Develop audit response and remediation strategies addressing root causes.
• Establish governance, KPI, and reporting to measure compliance effectiveness.

Skills

Healthcare compliance

Audit management

Regulatory knowledge

Data analysis

Stakeholder influence

Education

Bachelor's degree or equivalent

Master's degree preferred

Tools

Microsoft Excel

Job description

CVS Health Corporation seeks a strategic Manager, Medicaid Provider Compliance to shape compliance strategy and lead cross-functional initiatives across the organization. You will serve as a senior SME responsible for regulatory integrity and sustainable improvements that strengthen performance.

You will drive audit readiness, leverage data to optimize controls, and partner with senior leaders to reduce compliance risk while advancing operational excellence.