Manager, Medicare Business Compliance

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 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. + Overseethe Medicare Compliance ProgramforMA-PDandD-SNPinaccordancewithCMSPartC&D requirements. + Monitor,interpret, and communicateCMSregulatoryguidance;serveasacompliancesubjectmatterexpert to internalteams. + Maintain Medicare Compliance policies, procedures, and governance processes. + Lead Medicare complianceriskassessments,monitoring,andauditingactivities;overseeCAPdevelopment and validation. + Coordinate and supportCMSProgramAudits,internalaudits, and externalreviews. + Oversee compliance training, communications, and required regulatory reporting. + Reports to the Medicare Product department of Mercy Care. + Regular interaction with Medicare Compliance Committees, Audit & Compliance Committees, and operational leadership. Required 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. 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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. The benefits for this position include 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 (https://learn.bswift.com/cvshealth-mainland) . 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. CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace. To view full details and how to apply, please login or create a Job Seeker account