Ld Director, Medicaid Provider Compliance

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.A Brief Overview

TheLead Director, Provider Data Compliance is responsible for overseeing the compliance of provider data operations in support of federal requirements, state regulations, multiple health plan policies and contractual obligations. The position leads cross-functional initiatives to support audit readiness and collaborates with Compliance, Legal, Medicaid Health Plans, Network Contracting, and Provider Relations to ensure alignment with regulatory and contractual obligations. The Lead Director will also serve as a key liaison between Compliance, Legal, Network Contracting, and Provider Relations teams.

• A minimum of 7 years of healthcare payer experience, with at least 5 years in provider operations or compliance.
• A minimum of 2 years of experience in provider data management and contracting support.
• A minimum of 3 years managing, mentoring and growing a team.
• Demonstrated expertise in interpreting contracts and regulatory requirements.
• Proven ability to lead cross-functional teams and manage large-scale initiatives.
• Strong understanding of provider credentialing processes and data governance.
• Experience with audit preparation, policy development, and corrective action planning.

• NCQA credentialing experience.
• Familiarity with tools such as QuickBase, Excel, and provider data platforms.
• Project management experience.
• Strong analytical and data-driven decision-making skills.
• Ability to influence and collaborate across all levels of the organization.

• Bachelors degree preferred or a combination of equivalent professional work experience and education.

• 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.