Medicaid Risk Adjustment Market Manager

CVS Health

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary 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 monthly market meetings, translate performance data into actionable insights, and collaborate with cross functional partners to enhance provider engagement and member 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.
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.
Investigate 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.