Program Integrity Manager

About the role

The Program Integrity Manager serves as a key leader supporting Medicaid Program Integrity, Payment Integrity, and Special Investigations Unit (SIU) activities. This role is responsible for 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, and partnering with internal and external stakeholders to promote operational effectiveness and program integrity. The position works 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.

Responsibilities

• Ensure compliance with state and federal requirements for Medicaid Program Integrity and Payment Integrity.
• Support fraud, waste, and abuse (FWA) prevention efforts.
• Oversee regulatory and contractual obligations.
• Coordinate reporting and audit activities.
• Partner with internal and external stakeholders to promote operational effectiveness and program integrity.
• Collaborate with health plan leadership, compliance, SIU, payment integrity vendors, and operational teams.

Requirements

• 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.

Preferred Qualifications

• 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.

Education

Bachelor's degree or equivalent combination of education and experience.

Schedule

This is a full-time position with anticipated weekly hours of 40. 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, working onsite three days a week.

Pay

The typical pay range for this role is $60,300.00 - $132,600.00 annually. This pay range represents the 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 also eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range.

Benefits

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, including:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources.

Additional details about available benefits are provided during the application process and on Benefits Moments.