Manager, Medicare Business Compliance

CVS Health

1d•Onsite

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. Position Summary The Medicare Compliance Manager is responsible for supporting the compliance program in alignment with CMS requirements. This role serves as a people leader with direct management responsibility for Medicare Compliance staff and is responsible for audit readiness, regulatory monitoring, and risk assessment. The position provides subject matter expertise to internal business partners and supports the organization’s compliance culture, CMS audit performance, and ongoing regulatory obligations.

Requirements

Proven people‑management experience, including leading compliance staff or analysts.
Strong knowledge of CMS audit protocols, compliance program requirements, and regulatory reporting.
Strong planning, execution, problem‑solving, and decision‑making skills.
Ability to collaborate effectively with cross‑functional partners, senior leadership, and external regulators.
Bachelor’s degree in healthcare administration, business, compliance, or a related field and/or a minimum of 5–7 years of progressive Medicare compliance experience in lieu of a degree.

Nice To Haves

Prior experience supporting CMS Program Audits and managing corrective action plans.
Experience with delegation oversight and FDR compliance monitoring.
Healthcare compliance, regulatory, or auditing certification (e.g., CHC, CCEP) is a plus.

Responsibilities

Lead and manage Medicare Compliance staff, including workload prioritization, performance management, and development.
Oversee the Medicare Compliance Program for MA‑PD and D‑SNP in accordance with CMS Part C & D requirements.
Monitor, interpret, and communicate CMS regulatory guidance; serve as a compliance subject matter expert to internal teams.
Maintain Medicare Compliance policies, procedures, and governance processes.
Lead Medicare compliance risk assessments, monitoring, and auditing activities; oversee CAP development and validation.
Coordinate and support CMS Program Audits, internal audits, and external reviews.
Oversee compliance training, communications, and required regulatory reporting.
Reports to the Medicare Product department of Mercy Care.
Regular interaction with Medicare Compliance Committees, Audit & Compliance Committees, and operational leadership.