Note: The job is a remote job and is open to candidates in USA. CVS Health is focused on building a world of health around every individual, and they are seeking a Program Integrity Manager to support Medicaid Program Integrity and Payment Integrity activities. The role involves ensuring compliance with regulatory requirements and overseeing initiatives to prevent fraud, waste, and abuse.
Responsibilities
- Ensuring compliance with state and federal requirements
- Supporting fraud, waste, and abuse (FWA) prevention efforts
- Overseeing regulatory and contractual obligations
- Coordinating reporting and audit activities
- Partnering with internal and external stakeholders to promote operational effectiveness and program integrity
- Working closely with health plan leadership, compliance, SIU, payment integrity vendors, and operational teams to support initiatives that improve performance, strengthen oversight, and ensure compliance with applicable requirements
Skills
- 5+ years experience in Program Integrity, Payment Integrity, Special Investigations, Healthcare Compliance, Fraud, Waste and Abuse (FWA), Claims Operations, Healthcare Operations, or a related field
- Knowledge of healthcare regulatory and compliance requirements
- Strong analytical, organizational, communication, and problem-solving skills
- Ability to manage multiple priorities and work effectively in a collaborative environment
- Experience building relationships and working with cross-functional teams and external stakeholders
- Bachelor's degree or equivalent combination of education and experience
- Experience supporting Medicaid managed care programs
- Experience with regulatory reporting, audits, compliance initiatives, or operational oversight activities
- Experience working with SIU investigations, fraud prevention programs, vendor management, or payment integrity operations
- Knowledge of healthcare claims, provider reimbursement, payment accuracy, and program integrity practices
Benefits
- We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy.
- Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week.
- 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.
- 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
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