[Hiring] Medicaid Risk Adjustment Market Senior Manager @CVS Health

Role Description

We are seeking a highly motivated and strategic professional to serve as the Medicaid Market Senior Manager for our Risk Adjustment programs. This is a high-visibility role responsible for driving market level engagement, delivering insights, and demonstrating the value of Medicaid risk adjustment performance to senior leaders and market partners.

• Serve as the key connector between national Risk Adjustment strategy and 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 to 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.

Qualifications

• 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.
• Demonstrated experience using data, dashboards, reports, or performance metrics to identify opportunities and support business decisions.
• Demonstrated experience preparing and presenting business updates or recommendations to leadership or cross-functional stakeholders.
• Demonstrated experience facilitating meetings or working sessions with defined action items, owners, and timelines.

Requirements

• Critical thinking skills.
• 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.
• Thinks and acts strategically – Anticipates opportunities and challenges.
• Drives long-term strategies while maintaining focus on shorter-term objectives.
• Skilled at relationship building to foster effective working relations across the teams, including functional and divisional leaders.
• Ability to thrive in a fast-paced, highly visible role with competing priorities.
• Excellent communication skills with a demonstrated ability to present effectively to executive leadership.
• Strong analytical and problem-solving skills.
• Proven ability to lead projects end to end.
• Demonstrated ability to lead, coach, and develop managers while driving team accountability, prioritization, and execution across multiple markets.

Education

• Bachelor’s degree in Finance, Health Care Administration (required or 3 plus years of relevant work experience in lieu of degree).
• Previous work in Risk Adjustment and/or Medicaid and certification preferred.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.