Medicaid Risk Adjustment Market Manager
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Job Description
Medicaid Market Manager overseeing Risk Adjustment programs at CVS Health. Driving market engagement, performance insights, and value demonstration to senior leaders and partners.
Responsibilities:
- Function as a face of Revenue Integrity across internal market teams
- Develop and deliver executive level presentations highlighting key performance drivers, challenges, and solutions
- Investigates operational issues that impact market performance – work with business partners to implement solutions
- Track deliverables and identify barriers in market engagement in conjunction with implementing resolutions
- Assist with development of educational material to support market intelligence
- Engage with market clinical team, care management team, member services team; attend market level meetings as appropriate
- Apply project management skills to coordinate deliverables, track timelines, and manage competing priorities
- Work closely with the Informatics team to review requirements, dashboards, reports including any enhancements
- Utilize data analyses using national tools in conjunction with the corporate lead to identify areas of opportunity
- Produce and present market specific performance specific to Medicaid Revenue Integrity efforts at various governance, market, and executive leadership meetings
- Monitors program or programs that are jointly accountable for risk adjustment strategy, performance, and results within a designated market(s)
- Responsible for identifying and recommending nuanced market risk adjustment strategies and collaboratively executing tactics to focus, maximize and achieve market success, including market referrals
- Coordinate with local markets to drive correctness, completeness, accuracy, and timeliness of risk score performance
- Collaborate on market specific strategies that drive member engagement in risk adjustment programs
- Stay abreast of regulatory changes and leading risk adjustment practices and tools to maximize the effectiveness and efficiency of the team
- Partner with segment product, sales, network, clinical teams to implement processes aimed at strengthening member and provider engagement of Revenue Integrity programs resulting in improved outcomes
Requirements:
- 5+ years of progressive experience in healthcare operations, risk adjustment or related fields
- 2+ years analyzing performance data and building executive-ready narratives and materials that translate findings into clear recommendations (KPIs, trends, variance drivers, and actions)
- 3+ years leading cross-function projects, managing project plans/timelines and routing status reporting
- Strong presentation skills with ability to clearly communicate complex information to diverse audiences, including senior leadership
- Proven track record of leading and supporting meetings by capturing detailed, accurate notes, key decisions and action items
- Advanced proficiency in Microsoft PowerPoint; including ability to create clear, visually compelling, executive-level presentations
- Strong working knowledge of Microsoft Excel, with experience building tables, charts and dashboard to synthesize and communicate data effectively
- Ability to translate complex data into concise actionable insights using visuals and structured storytelling
- Rigorous follow up on takeaways, driving accountability and timely completion of next steps across stakeholders
- Knowledge of insurance regulatory and contractual requirements
- Self-starter who demonstrates initiative and displays a high energy level
- Intellectual curiosity and tenacity: strong ability to learn on the fly; to understand and solve complex problems
- Proven ability to lead projects end to end
Benefits:
- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- other resources, based on eligibility
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