Risk Adjustment Outreach Manager

CVS Health

1d•Remote

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. Under the direction of the Senior Manager of the RI Retro Ops Team, the Risk Adjustment Outreach Manager is responsible for leading initiatives that support the organization’s risk adjustment program and ensure timely and accurate data capture. In this role, you will manage large-scale projects, analyze performance data, and collaborate with key stakeholders. You will build vendor relationships and engage providers to drive successful chart retrieval efforts and achieve organizational goals.

Requirements

5–7 years of professional experience, preferably in healthcare operations, risk adjustment, or related fields.
Advanced proficiency in Microsoft Excel (pivot tables, VLOOKUP, data analysis, reporting).
Strong analytical, problem-solving, and project management skills.
Ability to work independently and manage priorities with minimal supervision.
Excellent verbal and written communication skills.
Proven ability to build relationships and collaborate across teams.
Experience managing complex territories and cross-functional projects.

Nice To Haves

Experience in risk adjustment, vendor management, and program management.
Familiarity with systems and tools used for chart retrieval and retrospective operations.
Negotiation skills and experience resolving provider participation barriers.

Responsibilities

Manage assigned territory within the risk adjustment program from planning through completion, including leading cross-functional meetings, setting timelines, and tracking progress.
Ensure timely and accurate chart retrieval by managing processes, resolving barriers, and maintaining compliance.
Conduct outreach to providers to address retrieval challenges and negotiate fees when necessary.
Extract data from vendor portals and update designated spreadsheets, ensuring accuracy and timeliness.
Build and maintain vendor relationships, monitor performance and risks.
Analyze data to identify trends and develop actionable insights for program optimization. Present findings to senior leadership and external stakeholders.
Track and report on key metrics to ensure retrieval targets and internal benchmarks are consistently achieved.
Partner with Market/Network teams and Provider Relations to align initiatives with organizational objectives.