[Hiring] Manager, Medicare Business Compliance @CVS Health

Role Description

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.

Key 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.
• Regular interaction with Medicare Compliance Committees, Audit & Compliance Committees, and operational leadership.

Qualifications

• 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.

Preferred Qualifications

• 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.

Education

• 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.

Anticipated Weekly Hours

• 40

Time Type

• Full time

Pay Range

The typical pay range for this role is: $60,300.00 - $132,600.00. 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.

Benefits

• Comprehensive and competitive mix of pay and benefits.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.

Application Information

We anticipate the application window for this opening will close on: 05/06/2026. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.