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.
About the Role
We are seeking a dynamic leader to drive Medicaid provider compliance, audit excellence, and regulatory integrity across our organization. In this role, you will lead strategic initiatives that ensure accurate, timely, and high-quality audit results, strengthen regulatory relationships, and implement proactive measures to mitigate risk. You’ll partner cross-functionally to optimize audit results and implement preventative measures to mitigate risk, while influencing best practices that enhance operational efficiency and compliance. If you are a proactive problem solver with strong leadership skills and a passion for delivering sustainable, compliant solutions, we want to hear from you.
Position Summary
Leads and ensures the delivery of high-quality internal and external Medicaid provider audit results, regulatory compliance activities, and proactive risk mitigation strategies. Applies deep expertise in compliance, business operations, analytics, and communication to develop and execute strategies that support regulatory and contractual obligations. Partners cross-functionally to support accurate, complete, and timely audit and regulatory deliverables, standardize processes, optimize workflows, and enable data integrity across the organization. Drives and supports provider compliance initiatives that promote consistency, accuracy, compliance, and operational excellence.
The ideal candidate is a strategic, solutions-oriented leader with strong analytical and communication skills, capable of influencing outcomes and implementing best practices that enhance audit performance, regulatory relationships, and operational efficiency. This role requires technical acumen, critical thinking, and the ability to lead complex initiatives in a dynamic environment.
Key Responsibilities
- Direct and foster best-in-class collaboration with internal teams and external auditors to deliver quality results, ensure continuous improvement, and maintain compliance.
- Interpret audit findings to recommend sustainable corrective actions and process improvements that mitigate risk.
- Support the response to complex inquiries from internal stakeholders and regulators with accuracy, timeliness, and completeness.
- Serve as a technical and functional leader, managing multiple compliance-related projects and deliverables to ensure timely execution and desired outcomes.
- Oversee policy and procedural documentation development and the timeliness of required annual reviews.
- Build and sustain productive partnerships across all organizational levels; exercise sound judgment, remove barriers, and influence ethical, compliant outcomes to achieve strategic goals.
Required Qualifications
- Minimum of 3 years of progressive experience in audit, compliance, or related healthcare operations.
- Proven ability to develop and execute detailed project plans with accountability and rigor to deliver complex initiatives successfully.
- Strong analytical skills with demonstrated ability to interpret data, identify trends, and recommend actionable solutions for compliance-related challenges.
- Experience with Microsoft Excel with advanced proficiency for data analysis and reporting to strengthen internal controls and mitigate risk.
- Exceptional ability to convey complex information clearly and concisely, build relationships across organizational levels, and influence decision-making.
- Ability to lead initiatives, mentor team members, and thrive in a fast-paced, evolving environment while maintaining compliance and quality standards.
Preferred Qualifications
- 5 years of progressive experience in audit, compliance, or related healthcare operations.
- Ability to interpret and apply business knowledge to implement state and federal laws and regulations impacting healthcare operations.
- Three or more years of demonstrated success leading audits, complex projects, ensuring timely delivery, and driving measurable outcomes.
- Three or more years of experience managing provider data operations, including compliance.
- Three or more years of experience in network management, contracting, or related healthcare network functions.
- One or more years of hands-on experience with provider data management platforms.
Education
- Bachelor's degree preferred/specialized training/relevant professional qualification.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$46,988.00 - $112,200.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- At least 3 years of progressive experience in audit, compliance, or related healthcare operations
- Ability to develop and execute detailed project plans for complex initiatives
- Strong analytical skills, including interpreting data, identifying trends, and recommending compliance solutions
- Advanced Microsoft Excel proficiency for data analysis and reporting
- Ability to communicate complex information clearly, build relationships, and influence decisions
- Ability to lead initiatives, mentor team members, and work effectively in a fast-paced environment while maintaining compliance and quality
- Bachelor's degree, specialized training, or relevant professional qualification
- Five years of progressive experience in audit, compliance, or related healthcare operations
- Ability to interpret and apply state and federal healthcare laws and regulations
- At least three years of experience leading audits and complex projects while driving measurable outcomes
- At least three years of experience managing provider data operations, including compliance
- At least three years of experience in network management, contracting, or related healthcare network functions
- At least one year of hands-on experience with provider data management platforms
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Health coverage is described as broad and robust, spanning medical, dental, vision, prescription, life, and disability insurance. Access to no-cost preventive care through MinuteClinic and virtual medical services further enhances the package.
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Wellbeing & Lifestyle Benefits — Wellness and education resources stand out, including tuition assistance, confidential counseling with generous session limits, virtual mental-health care, fitness programs, financial coaching, and employee discounts. Backup-care support and other lifestyle discounts add everyday value.
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Parental & Family Support — Family-oriented programs such as paid parental leave, adoption and surrogacy assistance, doula support, caregiving resources, and backup care are highlighted. These offerings indicate meaningful support for different life stages.
CVS Health Insights
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
