Strategic Medicaid Provider Compliance Leader

CVS Health Corporation; Saint Paul (MN); On-site; USD 54,000 - 159,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health Corporation is seeking a strategic Manager, Medicaid Provider Compliance to drive enterprise-wide compliance initiatives. You will shape strategy, lead cross-functional efforts, and influence senior leadership to strengthen regulatory performance and operational excellence.

You will oversee audit readiness, remediation, and data-driven controls, partnering with regulators, health plans, and legal teams to advance integrity and accountability across the organization.

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, manages risk, and translates regulatory requirements into business solutions.
• Lead compliance strategies that support contractual, regulatory, and business objectives and promote accountability.
• Serve as SME for provider compliance and audit readiness to improve data integrity and internal controls.
• Use data to optimize processes, strengthen controls, and deliver sustainable results.
• Build partnerships with senior leaders and influence outcomes across functions.
• Lead enterprise-wide provider compliance, audit preparedness, and regulatory initiatives.
• Develop audit response and remediation strategies addressing root causes.
• Influence cross-functional stakeholders to align priorities and implement compliance solutions.
• Assess emerging regulatory requirements and business risks to ensure preparedness.
• Lead high-visibility projects with governance, accountability, and risk management.
• Establish monitoring frameworks and KPIs to measure compliance effectiveness.
• Drive continuous improvement through process redesign and control optimization.
• Provide mentorship to analysts and compliance professionals.

Skills

Healthcare compliance

Audit management

Provider operations

Cross-functional leadership

Analytical skills

Data analysis

Regulatory knowledge

Stakeholder influence

Excel proficiency

Education

Bachelor's degree

Master's degree preferred

Tools

Excel

Job description

CVS Health Corporation is seeking a strategic Manager, Medicaid Provider Compliance to drive enterprise-wide compliance initiatives. You will shape strategy, lead cross-functional efforts, and influence senior leadership to strengthen regulatory performance and operational excellence.

You will oversee audit readiness, remediation, and data-driven controls, partnering with regulators, health plans, and legal teams to advance integrity and accountability across the organization.