Medicaid Risk Adjustment Market Manager

CVS Health•Hartford, IN

1d•$54,300 - $145,860•Remote

About The Position

We are seeking a highly motivated and strategic professional to serve as the Medicaid Market 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. The Medicaid Market Manager will serve as the key connector between national Risk Adjustment strategy and market execution, ensuring alignment, accountability, and measurable impact. The individual in this role will lead territory meetings with health plan executives and territory presidents, bringing actionable and important insights that inform decisions, address barriers, and support risk adjustment performance.

Requirements

5+ years of experience developing and delivering executive presentations (e.g., monthly/quarterly performance reviews) to senior leaders and cross functional audiences.
2+ years experience of health insurance regulatory and contractual requirements.
Demonstrated experience leading recurring territory meetings with health plan executives and territory presidents by presenting actionable insights, capturing decisions, assigning owners, documenting due dates, and driving closure within agreed timelines.
Demonstrated ability to independently research, gather, and validate information from multiples sources with minimal direction.
Advanced proficiency in Microsoft PowerPoint with 3+ years producing executive-ready decks that translate analytics into clear recommendations (charts, tables, storyline, and summary slides).
Proven ability to lead projects end-to-end, including defining scope, building project plans, and delivering milestones on time (e.g., 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.
Ensures rigorous follow up on takeaways, driving accountability and timely completion of next steps across stakeholders.
Maintains organized tracking of deliverables, action plans, and project milestones to ensure progress and visibility.
Effectively manages multiple priorities in a fast-paced, dynamic environment, adapting quickly to shifting business needs.
Exhibits strong attention to detail and organizational skills to support high-quality execution.
Collaborates cross-functionally with provider engagement, network, quality, and operations partners to align objectives, define required support, and advance risk adjustment priorities.
Proactively identifies risks, gaps, and dependencies, escalating as appropriate and proposing solutions.
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.
Bachelor’s Degree or equivalent work experience

Nice To Haves

Experience delivering presentations to Senior Executives and Provider groups
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.

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.
Lead territory meetings for health plan executives and territory presidents, bringing forward timely insights, priorities, and recommendations to support risk adjustment initiatives.
Lead working groups with provider engagement, network, and quality partners to determine the support required to advance risk adjustment initiatives.
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.