via Career.io
$44K - 94K a year
Assist in managing Medicare key performance indicators, conduct compliance reviews, analyze internal controls, and communicate findings to ensure regulatory adherence.
1-3 years Medicare Advantage/Medicaid experience, project management skills, data analysis proficiency, and ability to use Excel, PowerPoint, and QuickBase.
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.Position SummaryAssists in ensuring the organization adheres to contractual and regulatory requirements, mitigates risks, and maintains a strong compliance culture. Assists in the management of Medicare key performance indicators, including root cause and corrective action plan management for indicators not meeting goals.Contributes to implementing complex monitoring systems and procedures to assess compliance with contractual and regulatory requirements.Conducts reviews and assessments of various business activities and processes.Analyzes internal controls, policies, and procedures to identify weaknesses.Implements and modifies, under direct supervision, new key performance indicators to align with new and changing regulatory and contractual requirements.Compiles compliance reports and documentation, highlighting findings, recommendations, issue root cause analysis, and corrective action plans.Examines procedures and reporting, under close supervision, to ensure efficiency and appropriate risk mitigation.Communicates with internal teams to ensure accurate and timely reporting.Manages administrative tasks such as monitoring and taking action on department email account.Required Qualifications1-3 years of experience in with Medicare Advantage and/or Medicaid experience regulations and contractual requirementsProject management experience, including root cause and corrective action development and trackingProblem solving and decision-making skillsAbility to work in Excel, PowerPoint, and QuickBaseExperience with data analysis or compliance monitoring systemsGood verbal and written communicationPreferred QualificationsCompliance, audit, or quality management experienceFamiliarity with CMS audit protocols and reporting requirementsEducationBachelors degree preferred but can substitute experience.Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$43,888.00 - $93,574.00This 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: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.For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 12/01/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
This job posting was last updated on 12/1/2025