CVS Health · 17 hours ago
Manager, Medicare Compliance
United States
Full-time
Remote
Mid, Senior Level
$60K/yr - $133K/yr
5+ years expCVS Health is dedicated to building a world of health around every individual, and they are seeking a Medicare Compliance Manager to support and develop Medicare compliance programs. This role involves managing compliance strategies, maintaining relationships with stakeholders, and ensuring adherence to regulatory obligations in a complex environment.
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Responsibilities
Lead and implement an effective Compliance Program as described in CMS Medicare Managed Care Manuals/regulations, including risk assessment, auditing and monitoring and corrective action oversight
Develop and manage compliance strategies, programs, and processes that promote compliant and ethical behavior, meet regulatory obligations, and prevent, detect, and mitigate compliance risks
Track, analyze, research, interpret and monitor applicable CMS and to develop recommendations, direction, and escalation ensuring Aetna’s that implementation and integration of program requirements complies with federal and the CVS Code of Conduct
Maintain in-depth working knowledge and expertise in Medicare regulations
Builds and maintains positive relationships at senior levels to drive decision-making and influence ethical and compliant outcomes
Monitor and audit as outlined in Medicare Compliance Work Plan and direct other projects as assigned to evaluate compliance, propose remediation where necessary and monitor implementation of corrective action
Lead and support broader compliance initiatives and needs as assigned to ensure that effective compliance programs are achieved and maintained
Other duties as assigned
Qualification
Required
Minimum of 5 years' experience in Medicare Compliance or regulatory work
Willingness to travel up to 10% (including plane)
Extensive knowledge of Medicare compliance programs and rules
Experience in validation, auditing and monitoring, root cause analysis and corrective action oversight
Outstanding time management and project management
Proficient in utilization of information systems
Mastery of problem solving and decision-making skills
Adept at execution and delivery (planning, delivering, and supporting) skills
Adept at collaboration and teamwork
Preferred
Expertise in Medicare Appeals requirements
3+ years of Medicare Compliance work
Bachelor's Degree preferred; equivalent years of related professional work experience may substitute
Benefits
Affordable medical plan options
A 401(k) plan (including matching company contributions)
An employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility
Company
CVS Health
CVS Health is a health solutions company that provides an integrated healthcare services to its members.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$4BKey Investors
Michigan Economic Development CorporationStarboard Value
2025-08-15Post Ipo Debt· $4B
2025-07-17Grant· $1.5M
2019-11-25Post Ipo Equity
Leadership Team
David Joyner
President and Chief Executive Officer, CVS Health
Chandra McMahon
SVP & CISO
Recent News
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