Description

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:

As a Medicare Compliance Manager, you are an experienced/career level compliance position that applies compliance, regulatory, business, analytical and communication skills to support, manage and develop and execute Medicare compliance programs and processes that promote compliant and ethical behavior, meet regulatory obligations, and prevent, detect and mitigate compliance risks. This role will allow you to work independently, as well as collaboratively, with internal senior level corporate compliance and business teams that operate Medicare Advantage in a highly complex regulatory environment and highly matrixed organization environment with a current focus on integrated special needs plans. You will maintain productive relationships and open lines of communication with internal and key external stakeholders to effectively communicate and influence compliant outcomes and ensure that processes are enhanced or implemented to effectively address compliance requirements.

Responsibilities include, but are not limited to:

• 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.

In order to be successful in this role you must exhibit the following:

• 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

Required Qualifications:

• Minimum of 5 years' experience in Medicare Compliance or regulatory work
• Willingness to travel up to 10% (including plane)

Preferred Qualifications:

• Expertise in Medicare Appeals requirements
• 3+ years of Medicare Compliance work

Education:

Bachelor's Degree preferred; equivalent years of related professional work experience may substitute.

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.

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 our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 02/27/2026

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