About Us
At CVS Health, we're on a mission to revolutionize the way healthcare is delivered. With a commitment to putting our heart into every moment of your health, we strive to make healthcare more personal, convenient, and affordable. Our team is passionate about transforming the healthcare landscape, and we're looking for talented individuals to join us on this journey.
Job Summary
We're seeking an experienced and enthusiastic Full Stack Medicaid Risk Adjustment Manager to lead our suite of market-focused Risk Adjustment Programs for a portfolio of Aetna Better Health Medicaid Plans. As a key member of our Revenue Integrity team, you'll work closely with cross-functional leadership to establish and champion a local market culture committed to revenue integrity excellence. If you're a self-starter with a passion for risk adjustment and a knack for driving results, we want to hear from you.
Key Responsibilities
As a Full Stack Medicaid Risk Adjustment Manager, you'll be responsible for:
- Acting as a face of Revenue Integrity across internal market teams, leading market meetings and reporting out to market executive leadership on a monthly basis.
- Investigating operational issues that impact market performance and working with business partners to implement solutions.
- Tracking deliverables and identifying barriers in market engagement, collaborating with the team to implement resolutions.
- Assisting with the development of educational material to support market intelligence.
- Engaging with market clinical team, care management team, member services team, and attending market-level meetings as appropriate.
- Working closely with the Informatics team to review requirements, dashboards, and reports, including any enhancements.
- Utilizing data analyses using national tools in conjunction with the corporate lead to identify areas of opportunity.
- Producing and presenting dashboards specific to Medicaid Revenue Integrity efforts at various governance, market, and executive leadership meetings.
- Monitoring program or programs that are jointly accountable for risk adjustment strategy, performance, and results within a designated market(s).
- Identifying and recommending nuanced market risk adjustment strategies and collaboratively executing tactics to focus, maximize, and achieve market success.
- Executing on local market strategies to drive correctness, completeness, accuracy, and timeliness of risk score performance.
- Collaborating on market-specific strategies that drive member engagement in risk adjustment programs.
- Staying abreast of regulatory changes and leading risk adjustment practices and tools to maximize the effectiveness and efficiency of the team.
- Partnering 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
To be successful in this role, you'll need:
- 3+ years of business experience or project management in a relevant field.
- Knowledge of health insurance regulatory and contractual requirements.
- A self-starter mentality with a high energy level.
- Strong communication and/or presentation skills.
Preferred Qualifications
While not required, we're looking for candidates with:
- Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) certification.
- Prior experience in the Risk Adjustment field or Medicaid.
- Bachelor's Degree from an accredited four-year college or university or equivalent work experience in lieu of a degree.
What We Offer
As a Full Stack Medicaid Risk Adjustment Manager at CVS Health, you'll enjoy:
- A competitive salary range of $54,300.00 - $145,860.00, depending on experience, education, and other factors.
- A comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, and Employee Stock Purchase Plan.
- A fully-paid term life insurance plan and short-term and long-term disability benefits.
- Well-being programs, education assistance, free development courses, and a CVS store discount.
- PTO or vacation pay, paid holidays, and other time off consistent with relevant state law and Company policies.
Career Growth Opportunities
At CVS Health, we're committed to helping our employees grow and develop their careers. As a Full Stack Medicaid Risk Adjustment Manager, you'll have opportunities to:
- Develop your skills and expertise in risk adjustment and revenue integrity.
- Collaborate with cross-functional teams to drive business results and improve patient outcomes.
- Take on new challenges and responsibilities as you grow and develop in your role.
- Participate in training and development programs to enhance your skills and knowledge.
Work Environment and Company Culture
At CVS Health, we're proud of our inclusive and supportive work environment. As a Full Stack Medicaid Risk Adjustment Manager, you'll be part of a team that values:
- Collaboration and teamwork.
- Open communication and transparency.
- Continuous learning and development.
- Employee well-being and work-life balance.
How to Apply
If you're a motivated and experienced professional looking for a new challenge, we encourage you to apply for this exciting opportunity. Please submit your resume and a cover letter outlining your qualifications and experience. We can't wait to hear from you!
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