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.

　　Position Summary

　　Serves as the single point of contact for Kentucky 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.

　　• Kentucky 100% Dedicated role

　　Required Qualifications

　　• Must be located in Kentucky or willing to relocate to Kentucky

　　• 7 years of work experience required (graduate level education may substitute)

　　• Experience in a healthcare program integrity or compliance role

　　• Ability to travel up to 10% (approx. 2-3x per year, depending on business needs)

　　Preferred Qualifications

　　• Experience In Medicaid

　　• Experience with State Reporting

　　• Experience with Interpreting Contracts

　　• Exceptional Organizational Skills

　　• Excellent Written and Oral Communication Skills

　　• Ability To Interact with All Levels of The Organization.

　　• Working experience with DMS

　　EducationBachelor's degree or equivalent experiencePay Range

　　The typical pay range for this role is:

　　$54,300.00 - $117,000.00

　　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.

　　In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

　　For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

　　CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

　　You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

　　CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.