Medicaid Risk Adjustment Market Manager

This is a fully remote position, open to applicants in Arizona, +17 more states.

📋 Description

• Act as the Medicaid Market Manager overseeing Risk Adjustment initiatives.

• Facilitate market-level engagement by providing insights and showcasing the value of Medicaid risk adjustment performance to senior leadership and market stakeholders.

• Align the national Risk Adjustment strategy with local market execution.

• Conduct territory meetings with health plan executives and territory presidents.

• Create and present executive-level presentations addressing performance drivers, challenges, and proposed solutions.

• Examine operational issues impacting market performance and collaborate with business partners to devise solutions.

• Monitor deliverables, recognize obstacles, and implement corrective measures.

• Produce educational materials that enhance market intelligence.

• Lead working groups involving provider engagement, network, and quality partners.

• Organize deliverables, timelines, and competing priorities by utilizing project management expertise.

• Review requirements, dashboards, reports, and enhancements in collaboration with the Informatics team.

• Analyze data using national tools to uncover potential opportunities.

• Generate and present market-specific Medicaid Revenue Integrity performance reports.

• Supervise programs responsible for the risk adjustment strategy, performance, and results within assigned markets.

• Identify and propose tailored market risk adjustment strategies and implement tactics for achieving market success.

• Work with local markets to enhance the correctness, completeness, accuracy, and timeliness of risk score performance.

• Collaborate on market-specific strategies that promote member engagement.

• Keep track of regulatory changes and leading practices and tools in risk adjustment.

• Collaborate with product, sales, network, and clinical teams to enhance member and provider engagement and improve outcomes.

⛳️ Requirements

• Over 5 years of experience in developing and delivering executive presentations to senior leaders and cross-functional audiences.

• At least 2 years of experience with health insurance regulatory and contractual obligations.

• Proven experience leading recurring territory meetings with health plan executives and territory presidents.

• Ability to autonomously research, gather, and validate information from multiple sources with minimal guidance.

• Advanced skills in Microsoft PowerPoint.

• Over 3 years of experience creating executive-ready presentations that translate analytics into clear recommendations.

• Demonstrated capability to lead projects from inception to completion, including defining scope, developing project plans, and meeting milestones on schedule.

• More than 3 years of experience managing cross-functional initiatives with documented schedules, RAID logs, and status reports.

• Proficient in translating complex data into concise actionable insights using visuals and structured storytelling.

• Capability to handle multiple priorities in a fast-paced, dynamic setting.

• Strong attention to detail coupled with excellent organizational skills.

• Understanding of insurance regulatory and contractual obligations.

• Self-motivated individual with initiative and high energy.

• Intellectual curiosity and determination, with a knack for learning quickly and solving complex challenges.

• A Master’s degree or completion of a management development program is preferred.

• At least 2 years of experience in Medicaid operations, risk adjustment, or medical coding and documentation.

• Extensive knowledge of local markets within Aetna Medicaid.

• Bachelor’s Degree or equivalent professional experience.

🏝️ Benefits

• Bonus, commission, or short-term incentive program through CVS Health, in addition to base salary.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources to support physical, emotional, and financial well-being.