Senior Manager, Medicaid Risk Adjustment

This is a fully remote position, open to applicants in Arizona, +7 more states.

📋 Description

• Drive engagement at the market level for Medicaid Risk Adjustment initiatives.

• Provide insights and illustrate the value of Medicaid risk adjustment performance to senior executives and market partners.

• Link the national Risk Adjustment strategy to market-level execution.

• Ensure alignment, accountability, and measurable results.

• Lead meetings at both territory and market levels.

• Manage a team of managers tasked with fostering market engagement.

• Conduct tactical working sessions and determine subsequent steps.

• Convert performance data into actionable insights.

• Work in collaboration with cross-functional partners to enhance claims denial resolution, seize provider engagement opportunities, and improve member outcomes.

⛳️ Requirements

• Over 5 years of experience in business, operations, project management, or program management.

• At least 3 years of experience overseeing cross-functional initiatives, deliverables, deadlines, and stakeholder follow-up.

• Minimum of 2 years of experience in Medicaid, healthcare operations, risk adjustment, revenue integrity, claims, provider engagement, or similar healthcare programs.

• Proficient in utilizing data, dashboards, reports, or performance metrics to uncover opportunities and inform business decisions.

• Skilled in preparing and delivering business updates or recommendations to leadership or cross-functional stakeholders.

• Experienced in facilitating meetings or working sessions with clearly defined action items, owners, and timelines.

• Understanding of insurance regulatory and contractual requirements.

• Exceptional communication and presentation abilities, including presenting to executive leadership.

• Strong analytical and problem-solving capabilities.

• Ability to manage projects from inception to completion.

• Capability to lead, mentor, and develop managers while fostering team accountability, prioritization, and execution across various markets.

• A Bachelor’s degree in Finance or Healthcare Administration is required, or 3+ years of relevant work experience may be considered in lieu of a degree.

• Previous experience in Risk Adjustment and/or Medicaid and relevant certification is preferred.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Award target in the company’s equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being, based on eligibility.