Medicaid Risk Adjustment Market Manager

Job not on LinkedIn

🔥 4 minutes ago

🌵 Arizona, Connecticut, +16 more states – Remote

🌵 Arizona – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🐎 Kentucky – Remote 🏖️ New Jersey – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote

💵 $54.3k - $145.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🎲 Risk

👻 Ghost score 0%

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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

• Serve as the Medicaid Market Manager for Risk Adjustment programs • Drive market-level engagement, deliver insights, and demonstrate Medicaid risk adjustment performance value to senior leaders and market partners • Connect national Risk Adjustment strategy with market execution • Lead territory meetings with health plan executives and territory presidents • Develop and deliver executive-level presentations on performance drivers, challenges, and solutions • Investigate operational issues affecting market performance and work with business partners on solutions • Track deliverables, identify barriers, and implement resolutions • Develop educational materials supporting market intelligence • Lead working groups with provider engagement, network, and quality partners • Coordinate deliverables, timelines, and competing priorities using project management skills • Review requirements, dashboards, reports, and enhancements with the Informatics team • Analyze data using national tools to identify opportunities • Produce and present market-specific Medicaid Revenue Integrity performance reporting • Monitor programs accountable for risk adjustment strategy, performance, and results within designated markets • Identify and recommend nuanced market risk adjustment strategies and execute tactics to achieve market success • Coordinate with local markets to improve correctness, completeness, accuracy, and timeliness of risk score performance • Collaborate on market-specific strategies that drive member engagement • Monitor regulatory changes and leading risk adjustment practices and tools • Partner with product, sales, network, and clinical teams to strengthen member and provider engagement and improve outcomes

🎯 Requirements

• 5+ years of experience developing and delivering executive presentations to senior leaders and cross-functional audiences • 2+ years of experience with health insurance regulatory and contractual requirements • Experience leading recurring territory meetings with health plan executives and territory presidents • Ability to independently research, gather, and validate information from multiple sources with minimal direction • Advanced proficiency in Microsoft PowerPoint • 3+ years producing executive-ready decks that translate analytics into clear recommendations • Proven ability to lead projects end-to-end, including defining scope, building project plans, and delivering milestones on time • 3+ years owning cross-functional initiatives with documented schedules, RAID logs, and status reporting • Ability to translate complex data into concise actionable insights using visuals and structured storytelling • Ability to manage multiple priorities in a fast-paced, dynamic environment • Strong attention to detail and organizational skills • Knowledge of insurance regulatory and contractual requirements • Self-starter with initiative and a high energy level • Intellectual curiosity and tenacity, with the ability to learn on the fly and solve complex problems • Master’s degree or management development program preferred • 2+ years of experience in Medicaid operations, risk adjustment, or medical coding and documentation • Deep knowledge of local markets across Aetna Medicaid • Bachelor’s Degree or equivalent work experience

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being