Risk Adjustment Outreach Manager

CVS Health

5d

About The Position

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Job description: 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. A Brief Overview 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

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

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees