Program Integrity Manager

Were building a world of health around every individual shaping a more connected convenient and compassionate health experience. At CVS Health youll be surrounded by passionate colleagues who care deeply innovate with purpose hold ourselvesaccountable 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.

• 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.

• 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.

**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. Under the policy all hires for in-scope populations should be placed into a hybrid or office-based location working onsite three days a week.
Aetna Service Operations office/hub locations will be discussed with the selected candidate.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

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

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws.