Senior Manager, Medicaid Compliance - Provider Data Services (PDS)

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 Senior Manager, Medicaid Compliance - Provider Data Services (PDS) is a senior-level role responsible for advancing provider data compliance, audit readiness, and risk mitigation across markets. This role serves as a subject matter expert, leading audit readiness and execution, including centralized tracking, audit coordination, and executive reporting.

The position drives the development and implementation of standardized, scalable audit and compliance frameworks, including audit playbooks and corrective action (CAP) oversight. It ensures remediation efforts are aligned to root cause, effectively implemented, sustainable, and supported by audit-defensible documentation. Through proactive monitoring, analytics, and issue resolution, the role strengthens controls, identifies risks, and enhances overall compliance performance.

Operating with a high degree of autonomy, this individual partners across Compliance, Legal, Credentialing, Network, Operations, and Technology to influence outcomes and promote consistent, compliant practices. The ideal candidate is a strategic, results-oriented leader with strong compliance expertise, analytical capabilities, and the ability to influence without authority, delivering measurable improvements in audit performance, data integrity, and regulatory compliance.

Key Responsibilities:

• Audit Readiness & Execution: Lead end-to-end audit readiness and execution for internal and external audits, including coordination, evidence validation, and submission of accurate, complete, and audit-defensible responses; proactively identify and escalate risks, issues, and dependencies to prevent delays.
• Audit Tracking & Executive Reporting: Establish and maintain centralized tracking of audit activity (RFIs, deliverables, findings, and CAPs), monitor progress against timelines, validate status accuracy, and deliver clear, executive-ready reporting on audit performance, key risks, and outcomes.
• CAP & Remediation Oversight: Drive development, tracking, and validation of corrective action plans aligned to root cause; ensure milestones, ownership, and dependencies are clearly defined; proactively escalate at-risk items; and confirm remediation is effectively implemented and supported by audit-ready documentation.
• Compliance Oversight & SME Leadership: Serve as a subject matter expert on Medicaid regulatory requirements and high-risk provider data processes (e.g., terminations, sanctions, directory accuracy, system integrations), ensuring operational practices align with compliance and contractual expectations.
• Analytics, Monitoring & Continuous Improvement: Leverage data analysis, reporting, and automation to identify trends and emerging risks, perform root cause analysis of complex issues, and drive continuous improvements that strengthen controls and enhance compliance performance.
• Cross-Functional Influence & Capability Building: Build strong partnerships across Compliance, Credentialing, Network, Operations, and Technology; influence stakeholders to drive accountability and compliant outcomes; and provide coaching and guidance to promote audit readiness and a culture of continuous improvement.

Required Qualifications

• 7+ years of experience in provider data, healthcare compliance, or related operations.
• 3+ years proven success leading audits and compliance initiatives with measurable outcomes.
• Strong knowledge of healthcare regulatory requirements, risks, and internal control frameworks.
• Exceptional communication skills with the ability to convey complex information clearly and concisely.
• Demonstrated ability to operate effectively in a fast-paced, evolving environment while maintaining quality and compliance standards.

Preferred Qualifications

• Experience interpreting and applying state and federal Medicaid regulations.
• Experience developing audit frameworks, playbooks, or compliance monitoring solutions.

Education

• Bachelor's degree or equivalent combination of education, training, and relevant experience.

Pay Range

The typical pay range for this role is:

$67,900.00 - $199,144.00

This 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. This position also includes an award target in the company's equity award program.

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.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 06/15/2026

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