Program Integrity Manager

Position Summary

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.

• 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.

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

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 at a CVS Health location.

40 hours per week

The typical pay range for this role is: $54,300.00 – $. The actual base salary offer will depend on experience, education, geography and other factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay.

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 based on eligibility.

The application window for this opening will close on: 08/15/2026.