CVS Health
Senior Manager, Corporate Compliance (Medicare Duals)
CVS Health, Downers Grove, Illinois, United States, 60516
3 days ago – Apply early: be among the first 25 applicants.
Position Summary The Sr. Manager is a career‑level compliance professional who applies compliance, regulatory, business, analytical and communication skills to support, manage, and develop Medicare and Medicaid compliance programs. This role promotes compliant and ethical behavior, meets regulatory obligations, and mitigates compliance risks for Medicare Advantage and integrated special needs plans in a complex, highly matrixed organization.
Responsibilities
Serve as plan compliance officer for assigned Special Needs Plans (SNPs).
Lead and implement an effective Compliance Program in line with CMS Medicare Managed Care Manuals, Medicaid rules, and government contracts, including risk assessment, auditing, monitoring, and corrective action oversight.
Develop and manage compliance strategies, programs, and processes that promote compliance and ethical behavior.
Track, analyze, research, and interpret applicable CMS and state regulations and government contract requirements; develop recommendations and escalation plans.
Maintain in‑depth knowledge of Medicare, Medicaid, and state requirements, regulations, and contracts for special needs plans.
Facilitate compliance and contract‑related communications, deliverables, and activities with regulators.
Manage timely and accurate responses to regulatory interactions, including preparing and responding to regulatory inquiries.
Lead or support external regulatory review and audit activities, including state Medicaid and related agency audits, and manage corrective action plans to closure.
Build and maintain positive relationships with internal and external constituents at senior levels to drive decision‑making and ethical outcomes.
Monitor and audit as outlined in the Medicare Compliance Work Plan; direct projects to evaluate compliance and implement corrective actions.
Utilize and maintain current information systems, such as Microsoft products and compliance tools (e.g., Archer).
Lead and support broader compliance initiatives as assigned.
Perform other duties as required.
Qualifications Required
7+ years’ experience in Medicare or Medicare Advantage government healthcare program compliance or regulatory work.
2+ years of project management experience.
Ability to travel up to 10%.
Preferred
Extensive knowledge of Medicare and Medicaid compliance programs and rules, including rules applying to integrated duals plans.
Education Bachelor’s Degree required.
Pay Range $82,940.00 – $182,549.00. The actual base salary offers vary by experience, education, geography, and other factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program and an equity award program target.
Benefits
Affordable medical plan options, 401(k) plan with company match, and employee stock purchase plan.
No‑cost programs for all colleagues: wellness screenings, tobacco cessation, weight management, confidential counseling, and financial coaching.
Benefit solutions addressing diverse needs: paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access, and many other benefits (subject to eligibility).
Application window closes on: 12/22/2025.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Seniority Level Mid-Senior level
Employment Type Full‑time
Job Function Legal
Industries Hospitals and Health Care
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Position Summary The Sr. Manager is a career‑level compliance professional who applies compliance, regulatory, business, analytical and communication skills to support, manage, and develop Medicare and Medicaid compliance programs. This role promotes compliant and ethical behavior, meets regulatory obligations, and mitigates compliance risks for Medicare Advantage and integrated special needs plans in a complex, highly matrixed organization.
Responsibilities
Serve as plan compliance officer for assigned Special Needs Plans (SNPs).
Lead and implement an effective Compliance Program in line with CMS Medicare Managed Care Manuals, Medicaid rules, and government contracts, including risk assessment, auditing, monitoring, and corrective action oversight.
Develop and manage compliance strategies, programs, and processes that promote compliance and ethical behavior.
Track, analyze, research, and interpret applicable CMS and state regulations and government contract requirements; develop recommendations and escalation plans.
Maintain in‑depth knowledge of Medicare, Medicaid, and state requirements, regulations, and contracts for special needs plans.
Facilitate compliance and contract‑related communications, deliverables, and activities with regulators.
Manage timely and accurate responses to regulatory interactions, including preparing and responding to regulatory inquiries.
Lead or support external regulatory review and audit activities, including state Medicaid and related agency audits, and manage corrective action plans to closure.
Build and maintain positive relationships with internal and external constituents at senior levels to drive decision‑making and ethical outcomes.
Monitor and audit as outlined in the Medicare Compliance Work Plan; direct projects to evaluate compliance and implement corrective actions.
Utilize and maintain current information systems, such as Microsoft products and compliance tools (e.g., Archer).
Lead and support broader compliance initiatives as assigned.
Perform other duties as required.
Qualifications Required
7+ years’ experience in Medicare or Medicare Advantage government healthcare program compliance or regulatory work.
2+ years of project management experience.
Ability to travel up to 10%.
Preferred
Extensive knowledge of Medicare and Medicaid compliance programs and rules, including rules applying to integrated duals plans.
Education Bachelor’s Degree required.
Pay Range $82,940.00 – $182,549.00. The actual base salary offers vary by experience, education, geography, and other factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program and an equity award program target.
Benefits
Affordable medical plan options, 401(k) plan with company match, and employee stock purchase plan.
No‑cost programs for all colleagues: wellness screenings, tobacco cessation, weight management, confidential counseling, and financial coaching.
Benefit solutions addressing diverse needs: paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access, and many other benefits (subject to eligibility).
Application window closes on: 12/22/2025.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Seniority Level Mid-Senior level
Employment Type Full‑time
Job Function Legal
Industries Hospitals and Health Care
#J-18808-Ljbffr