Executive Director, Medicaid Program Integrity

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CVS Health is seeking an Executive Director, Medicaid Program Integrity to provide executive leadership for Medicaid Program Integrity and Regulatory Affairs. This role involves establishing strategy, governance, regulatory engagement, and operational oversight to ensure compliance, mitigate risk, protect program dollars, and support business growth. The Executive Director will be the senior subject matter expert for Medicaid Payment Integrity, overseeing FWA prevention, payment accuracy, regulatory compliance, government agency engagement, and policy governance.

Key responsibilities include leading a team to manage government agency requirements, serving as an executive liaison with state Medicaid agencies and CMS, directing responses to audits and investigations, and developing enterprise-wide policies and strategies. The role requires 12+ years of progressive leadership experience in Medicaid Program Integrity, Payment Integrity, Compliance, or related healthcare functions, with deep expertise in Medicaid managed care regulations and FWA programs.

We’re building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable 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.

At Aetna, our health benefits business, we are committed to helping our members achieve their best health in an affordable, convenient, and comprehensive manner. Combining the assets of our health insurance products and services with CVS Health’s unrivaled presence in local communities and their pharmacy benefits management capabilities, we’re joining members on their path to better health and transforming the health care landscape in new and exciting ways every day.

Aetna is recruiting for an Executive Director, Medicaid Program Integrity to provide executive leadership for Medicaid Program Integrity and Regulatory Affairs across the enterprise, establishing strategy, governance, regulatory engagement, and operational oversight to ensure compliance, mitigate risk, protect program dollars, and support business growth. This leader will serve as the organization's senior subject matter expert for Medicaid Payment Integrity, overseeing fraud, waste and abuse (FWA) prevention, payment accuracy, regulatory compliance, government agency engagement, and policy governance across the Medicaid business.

This Executive Director will lead a team responsible for managing regulatory inquiries, audits, investigations, Requests for Information (RFIs), reporting obligations, and compliance activities involving state Medicaid agencies, Medicaid Fraud Control Units (MFCUs), CMS, and other regulatory bodies. Partners closely with Medicaid executive leadership to establish standardized operating practices, identify and mitigate regulatory risk, drive operational excellence, and advance strategic growth initiatives across multiple Medicaid markets.

• Develop and execute enterprise-wide Program Integrity and Regulatory Affairs strategies that support Medicaid business objectives, regulatory compliance requirements, operational effectiveness, and long-term growth initiatives.
• Provide executive oversight of Medicaid Payment Integrity programs, including payment accuracy, over payment recovery, fraud, waste and abuse prevention, provider oversight, auditing, monitoring, investigations, and compliance activities.
• Lead and develop a high-performing team responsible for managing all government agency requirements related to Medicaid Program Integrity and Payment Integrity programs.
• Serve as the executive liaison with state Medicaid agencies, Medicaid Fraud Control Units (MFCUs), CMS, auditors, regulators, and…