Senior Manager, Revenue Integrity Medicare Strategic Programs

CVS Health

2d

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. This is an individual contributor role POSITION SUMMARY: Reporting to the Lead Director of Medicare Revenue Integrity (RI), the Sr. Manager, will work closely with various RI Lead Directors and subject matter experts across the Medicare business to establish and champion market level revenue integrity excellence. This position is responsible for supporting all assigned market level risk adjustment activities and processes related to complete and accurate diagnosis capture through provider and member engagement. In support of the RI Medicare Performance Management Office (PMO) this position will lead the work and deliverables of multiple complex projects, focusing on process improvement, production, and data analysis. Individual should have proven project management of multiple complex projects simultaneously and demonstrate understanding of root cause analysis. This position may act as a liaison with other key business areas, internally and externally. The Medicare Risk Adjustment Sr. Manager will play a critical role in extracting, analyzing, and interpreting healthcare and financial data from multiple sources to address business opportunities regarding population health management, health and economic outcomes, and other business needs.

Requirements

• A minimum of 5 years of experience with Medicare Risk Adjustment.
• A minimum of 2 years of data analytics experience, using data to tell a story.
• Proven ability to manage multiple projects simultaneously and meet deadlines.
• Ability to manipulate the data using Microsoft Excel.

Nice To Haves

• Proven ability to develop, structure, and deliver high‑quality executive presentations that communicate complex information with clarity, precision, and strategic insight.
• Demonstrated experience presenting to senior leadership and C‑suite audiences, utilizing strong data storytelling, visual design standards, and executive‑level communication skills to support decision‑making and influence business outcomes.

Responsibilities

• Develop & execute strategies to enhance risk adjustment performance and meet organizational goals.
• Own, maintain, and develop Medicare PMO reporting and related artifacts.
• Collaborate cross functionally to support and maintain Medicare PMO goal setting and budget/forecast processes.
• Strategize on program improvement opportunities in conjunction with Medicare Analytics team to identify and implement data enhancements and resolve issues.
• Assemble and analyze data to produce Medicare reporting specific to Revenue Integrity efforts for various governance, market, and executive leadership meetings.
• Collaborate with market leads to identify and recommend nuanced market risk adjustment strategies and collaboratively executing tactics to focus, maximize and achieve market success.
• Communicate effectively with internal teams, health plan executives, and external stakeholders on risk adjustment matters.
• Support the development of clear and concise communication materials related to risk adjustment initiatives.
• Foster a culture of awareness and understanding regarding the importance of risk adjustment across the organization.
• Recruit, develop and retain a high performing, high quality risk adjustment talent pool that is respected within Medicare operations.
• Develop the skills and abilities of all team members to optimize their performance and create succession plans for future leaders that can take on roles with increasing responsibilities.
• Monitor industry trends and best practices to inform continuous improvement initiatives.

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: Mid Level
• Number of Employees: 5,001-10,000 employees