Senior Manager, Medicaid Risk Adjustment

Job not on LinkedIn

🕒 3 days ago

🌵 Arizona, Colorado, +6 more states – Remote

🌵 Arizona – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🏈 Ohio – Remote 🔔 Pennsylvania – Remote 🤠 Texas – Remote

💵 $75.4k - $166k / year

⏰ Full Time

🟠 Senior

🎲 Risk

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Drive market-level engagement for Medicaid Risk Adjustment programs • Deliver insights and demonstrate the value of Medicaid risk adjustment performance to senior leaders and market partners • Connect national Risk Adjustment strategy with market execution • Ensure alignment, accountability, and measurable impact • Lead territory and market-level meetings • Oversee a team of managers responsible for delivering market engagement • Facilitate tactical working sessions and process next steps • Translate performance data into actionable insights • Collaborate with cross-functional partners to advance claims denial resolution, provider engagement opportunities, and member outcomes

🎯 Requirements

• 5+ years of business, operations, project management, or program management experience • 3+ years of experience managing cross-functional initiatives, deliverables, timelines, and stakeholder follow-up • 2+ years of experience in Medicaid, health care operations, risk adjustment, revenue integrity, claims, provider engagement, or related health care programs • Experience using data, dashboards, reports, or performance metrics to identify opportunities and support business decisions • Experience preparing and presenting business updates or recommendations to leadership or cross-functional stakeholders • Experience facilitating meetings or working sessions with defined action items, owners, and timelines • Knowledge of insurance regulatory and contractual requirements • Excellent communication and presentation skills, including presentation to executive leadership • Strong analytical and problem-solving skills • Ability to lead projects end to end • Ability to lead, coach, and develop managers while driving team accountability, prioritization, and execution across multiple markets • Bachelor’s degree in Finance or Health Care Administration required, or 3+ years of relevant work experience in lieu of degree • Previous work in Risk Adjustment and/or Medicaid and certification 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 • Other resources supporting physical, emotional, and financial well-being, based on eligibility