Program Integrity Manager

CVS Health•New York, NV

1d•$54,300 - $145,860•Hybrid

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 Program Integrity Manager serves as a key leader supporting Medicaid Program Integrity, Payment Integrity, and Special Investigations Unit (SIU) activities. This role is responsible for ensuring compliance with state and federal requirements, supporting fraud, waste, and abuse (FWA) prevention efforts, overseeing regulatory and contractual obligations, coordinating reporting and audit activities, and partnering with internal and external stakeholders to promote operational effectiveness and program integrity. The position works closely with health plan leadership, compliance, SIU, payment integrity vendors, and operational teams to support initiatives that improve performance, strengthen oversight, and ensure compliance with applicable requirements.

Requirements

5+ years experience in Program Integrity, Payment Integrity, Special Investigations, Healthcare Compliance, Fraud, Waste and Abuse (FWA), Claims Operations, Healthcare Operations, or a related field.
Knowledge of healthcare regulatory and compliance requirements.
Strong analytical, organizational, communication, and problem-solving skills.
Ability to manage multiple priorities and work effectively in a collaborative environment.
Experience building relationships and working with cross-functional teams and external stakeholders.

Nice To Haves

Experience supporting Medicaid managed care programs.
Experience with regulatory reporting, audits, compliance initiatives, or operational oversight activities.
Experience working with SIU investigations, fraud prevention programs, vendor management, or payment integrity operations.
Knowledge of healthcare claims, provider reimbursement, payment accuracy, and program integrity practices.

Responsibilities

Ensuring compliance with state and federal requirements
Supporting fraud, waste, and abuse (FWA) prevention efforts
Overseeing regulatory and contractual obligations
Coordinating reporting and audit activities
Partnering with internal and external stakeholders to promote operational effectiveness and program integrity
Working closely with health plan leadership, compliance, SIU, payment integrity vendors, and operational teams to support initiatives that improve performance, strengthen oversight, and ensure compliance with applicable requirements.