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About the Role

We are seeking a strategic compliance leader to drive Medicaid provider compliance, audit readiness, regulatory integrity, and enterprise risk management. This role involves shaping compliance strategy, leading cross-functional initiatives, influencing business decisions, and advancing solutions to strengthen regulatory performance and operational excellence. You will partner with executive leadership, health plan stakeholders, compliance, legal, provider operations, and external auditors to identify compliance risks, develop mitigation strategies, and establish best-in-class audit and compliance practices.

Responsibilities

Lead enterprise-wide provider compliance, audit preparedness, and regulatory initiatives.
Serve as the primary subject matter expert for complex provider compliance matters.
Develop and execute audit response and remediation strategies.
Influence cross-functional stakeholders and senior leadership.
Assess emerging regulatory requirements, contractual obligations, and business risks.
Lead complex, high-visibility projects spanning multiple departments.
Establish and maintain compliance monitoring frameworks, key performance indicators, and reporting mechanisms.
Drive continuous improvement efforts through process redesign, automation, control optimization, and best practice implementation.
Provide mentorship, guidance, and technical leadership to analysts and compliance professionals.
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.

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
Experience with Medicaid provider compliance, provider data management, and healthcare network operations (Preferred)
Proven success leading audits, compliance programs, and process improvement initiatives (Preferred)
Experience developing compliance frameworks, controls, and governance programs (Preferred)
Strong partnership experience with regulators, auditors, and senior leadership (Preferred)
Knowledge of provider data systems, reporting tools, and compliance monitoring (Preferred)

Skills

Medicaid provider compliance
Audit readiness
Regulatory integrity
Enterprise risk management
Compliance strategy
Cross-functional initiative leadership
Stakeholder influence
Regulatory environments
Organizational change
Business outcomes
Provider compliance
Audit management
Regulatory oversight
Contractual compliance
Risk awareness
Data integrity
Internal controls
Process standardization
Organizational performance
Strategic decision-making
Emerging compliance risks
High-impact compliance initiatives
Analytical capabilities
Executive-level communication
Sustainable compliance outcomes
Audit response strategies
Remediation strategies
Root cause analysis
Control improvement
Long-term compliance improvements
Priority alignment
Challenge resolution
Effective compliance solutions
Regulatory requirements assessment
Contractual obligations assessment
Business risks assessment
Proactive compliance strategies
Operational readiness
Project governance
Risk management
Project execution
Compliance monitoring frameworks
Key performance indicators (KPIs)
Reporting mechanisms
Compliance effectiveness measurement
Continuous improvement
Process redesign
Automation opportunities
Control optimization
Best practice implementation
Mentorship
Guidance
Technical leadership
Organizational capability development
Knowledge development
Relationship building
Regulator relations
Auditor relations
Health plan relations
Provider relations
Legal relations
Compliance relations
Operational leadership relations
Audit outcome presentation
Compliance risk presentation
Trend presentation
Recommendation presentation
Healthcare compliance
Provider operations
Project leadership
Audit management
CAP management
Regulatory response management
Analytical skills
Risk assessment
Problem-solving skills
Medicaid regulations
Provider compliance requirements
Communication skills
Stakeholder influence skills
Results-driven
Priority management
Excel proficiency
Data analysis proficiency
Provider data management
Healthcare network operations
Compliance program leadership
Process improvement leadership
Compliance framework development
Control development
Governance program development
Partnership experience
Provider data systems
Reporting tools
Compliance monitoring
Strategic leadership
Business acumen
Risk management
Regulatory requirement translation
Business solution development
Influence skills
Stakeholder engagement
Trusted partnership building
Senior leader communication
Cross-functional influence
Operational excellence
Continuous improvement
Data utilization
Compliance expertise
Process optimization
Control strengthening
Sustainable results delivery

Work Type

Full time

Experience Level

7+ years of healthcare compliance, audit, or provider operations experience

Education Level

Bachelor's degree
Master's degree in Healthcare Administration, Business Administration, Public Health, Compliance, or related field preferred
Equivalent combination of education, specialized training, and relevant experience may be considered

Salary/Compensations

$54,300.00 - $159,120.00

Benefits

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs

About the Company

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.

Equal Opportunity

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.