This position can be work from home anywhere in the United States. Must be willing to work EDT schedule on a daily basis.

Serves as the single point of contact for state Medicaid programs for all program integrity related issues. This includes regulatory reporting, coordinating interdepartmental program integrity initiatives, vendor oversight of fraud waste and abuse (FWA) activity, and identifying services at risk for FWA. You will be responsible for compliance with state and federal regulations mandating the reporting of corporate fraud related activities and the preparation of the corporate Anti-Fraud Plan.

Additionally, you will:

• Utilize your experience and knowledge to comprehend and implement Medicaid regulations and contracts
• Coordinate with department leaders to fulfill the requirements of the program integrity unit
• Comply with all program integrity related requests, both internal and external, and meet request timelines
• Ability to handle and maintain confidential and sensitive information pertaining to providers.
• Maintain the Annual Fraud Plan, Risk Assessments and Work Plan including any health plan addendums
• Collaboration with plan compliance teams, including Audit preparation and Readiness Review oversight
• Act as a liaison with state Medicaid agencies, MFCU and other state law enforcement
• State reporting oversight and submission, as well as coordination of Vendor FWA activities
• Draft requests for proposal on new/rebidding of contracts
• Annual plan FWA training

To be successful, you will utilize your excellent stakeholder relationship management skills to collaborate with state partners and internal teams. Your ability to organize and manage multiplies priorities will also be critical to your success.

Pay Range
The typical pay range for this role is:
Minimum: 60,300
Maximum: 130,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

• 7 years of work experience required (graduate level education may substitute)
• Experience in a healthcare program integrity or compliance role
• Strong analytical and research skills
• Proficient in researching information and identifying

information resources

• Proficiency in Word, Excel, MS Outlook products, Database search tools, and use in the Intranet/Internet to research information
• Ability to travel up to 10% (approx. 2-3x per year, depending on business needs)

Preferred Qualifications

• Experience in Medicaid
• Experience with interpreting contracts
• Exceptional organizational skills
• Excellent written and oral communication skills
• Ability to interact with all levels of the organization.

Education

• Bachelor's degree or equivalent experience

Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.