Manager, Medicaid Provider Compliance

CVS Health•Washington, DC

3d•$54,300 - $159,120

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. We are seeking a strategic compliance leader to drive Medicaid provider compliance, audit readiness, regulatory integrity, and enterprise risk management across the organization. This role serves as a senior subject matter expert responsible for shaping compliance strategy, leading complex cross-functional initiatives, influencing business decisions, and advancing sustainable solutions that strengthen regulatory performance and operational excellence. The successful candidate will partner with executive leadership, health plan stakeholders, compliance, legal, provider operations, and external auditors to proactively identify compliance risks, develop enterprise-wide mitigation strategies, and establish best-in-class audit and compliance practices. This position requires an influential leader who can navigate complex regulatory environments, drive organizational change, and deliver measurable business outcomes. Provides enterprise leadership for Medicaid provider compliance, audit management, and regulatory oversight activities. Leads the development and execution of compliance strategies that support contractual, regulatory, and business objectives while promoting a culture of accountability, continuous improvement, and risk awareness. Serves as a recognized subject matter expert for provider compliance and audit readiness, driving initiatives that improve data integrity, strengthen internal controls, standardize processes, and enhance organizational performance. Partners across business areas to influence strategic decisions, manage emerging compliance risks, and ensure successful execution of high-impact compliance initiatives. The ideal candidate combines deep regulatory expertise, exceptional analytical capabilities, executive-level communication skills, and proven success leading complex initiatives that drive sustainable compliance outcomes.

Requirements

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
Bachelor's degree.
Equivalent combination of education, specialized training, and relevant experience may be considered.

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 related field preferred.

Responsibilities

Lead enterprise-wide provider compliance, audit preparedness, and regulatory initiatives that support organizational objectives and reduce compliance risk.
Serve as the primary subject matter expert for complex provider compliance matters, providing strategic guidance to leadership and business partners.
Develop and execute audit response and remediation strategies that address root causes, improve controls, and drive long-term compliance improvements.
Influence cross-functional stakeholders and senior leadership to align priorities, resolve challenges, and implement effective compliance solutions.
Assess emerging regulatory requirements, contractual obligations, and business risks; develop proactive strategies to ensure compliance and operational readiness.
Lead complex, high-visibility projects spanning multiple departments, ensuring effective governance, accountability, risk management, and successful execution.
Establish and maintain compliance monitoring frameworks, key performance indicators, and reporting mechanisms to measure compliance effectiveness and identify opportunities for improvement.
Drive continuous improvement efforts through process redesign, automation opportunities, control optimization, and best practice implementation.
Provide mentorship, guidance, and technical leadership to analysts and compliance professionals, fostering organizational capability and knowledge development.
Build and maintain strong 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 leadership and executive stakeholders.