Manager, Medicaid Provider Compliance

CVS Health•Hartford, WA

8d•$54,300 - $159,120

About The Position

CVS Health is seeking a strategic compliance leader to drive Medicaid provider compliance, audit readiness, regulatory integrity, and enterprise risk management. The Manager, Medicaid Provider Compliance serves as a senior subject matter expert who shapes compliance strategy, leads complex cross-functional initiatives, influences business decisions, and advances sustainable solutions to strengthen regulatory performance and operational excellence. The role partners with executive leadership, health plan stakeholders, compliance, legal, provider operations, and external auditors to identify compliance risks, develop enterprise-wide mitigation strategies, and establish effective audit and compliance practices. It also provides technical leadership and mentorship to analysts and compliance professionals.

Requirements

At least 7 years of healthcare compliance, audit, or provider operations experience.
Proven ability to lead complex projects and compliance initiatives.
Experience managing audits, corrective action plans (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.
Bachelor's degree or equivalent work experience.

Nice To Haves

Experience with Medicaid provider compliance, provider data management, and healthcare network operations.
Proven success leading audits, compliance programs, and process improvement initiatives.
Experience developing compliance frameworks, controls, and governance programs.
Strong partnership experience with regulators, auditors, and senior leadership.
Knowledge of provider data systems, reporting tools, and compliance monitoring.
Master's degree in Healthcare Administration, Business Administration, Public Health, Compliance, or a related field.

Responsibilities

Drive enterprise priorities, manage risk, and translate regulatory requirements into business solutions.
Lead the development and execution of compliance strategies supporting contractual, regulatory, and business objectives while promoting accountability, continuous improvement, and risk awareness.
Serve as a subject matter expert for provider compliance and audit readiness, driving improvements in data integrity, internal controls, standardized processes, and organizational performance.
Use data and compliance expertise to optimize processes, strengthen controls, and deliver sustainable results.
Build trusted partnerships, communicate with senior leaders, and influence outcomes across functions.
Lead enterprise-wide provider compliance, audit preparedness, and regulatory initiatives to support organizational objectives and reduce compliance risk.
Provide strategic guidance to leadership and business partners on complex provider compliance matters.
Develop and execute audit response and remediation strategies that address root causes, improve controls, and support long-term compliance improvements.
Influence cross-functional stakeholders and senior leadership to align priorities, resolve challenges, and implement compliance solutions.
Assess emerging regulatory requirements, contractual obligations, and business risks, and develop proactive compliance and operational-readiness strategies.
Lead complex, high-visibility, multi-department projects, ensuring governance, accountability, risk management, and execution.
Establish and maintain compliance monitoring frameworks, key performance indicators, and reporting mechanisms to measure effectiveness and identify improvement opportunities.
Drive continuous improvement through process redesign, automation opportunities, control optimization, and best-practice implementation.
Mentor and guide analysts and compliance professionals, fostering organizational capability and knowledge development.
Maintain working relationships with regulators, auditors, health plans, provider relations teams, legal, compliance, and operational leadership.
Present audit outcomes, compliance risks, trends, and recommendations to senior and executive leadership.