Senior Manager Revenue Integrity, Provider Performance (Northeast Territory)

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. Ideal candidate will sit in the Northeast Region This is an individual contributor The Senior Manager, Revenue Integrity, Provider Optimization & Enablement is responsible for executing a comprehensive risk adjustment strategy that supports health care systems and physicians participating in value-based care contracts. Develops a comprehensive risk adjustment strategy aligned with organizational goals and value-based contract requirements to providers. Implements market-specific risk adjustment initiatives to maximize performance and outcomes with assigned physician groups. Drives execution of key risk adjustment deliverables, ensuring alignment with quality, compliance, and financial objectives. Monitor performance metrics and trends related to risk adjustment and provider coding accuracy. Partners with physicians, health systems, vendors and internal partners to improve documentation, coding accuracy, and compliance. Support provider education and engagement initiatives related to risk adjustment and clinical documentation improvement. Ensure timely delivery of assigned projects, meeting defined scope, quality, and performance outcomes. Track progress, manage risks, and escalate issues as needed. Understands market specific provider performance and provider data impacts to downstream operational, financial & compliance results; identifies issues and works collaboratively to proactively address/design and remediate when needed.

Requirements

• Minimum of seven (7) years of experience supporting Medicare, Medicaid, and/or ACA health plans.
• Demonstrated experience in Medicare and/or Medicaid risk adjustment, value-based care models, provider performance, or population health initiatives.
• Working knowledge of both prospective and retrospective programs.

Nice To Haves

• Demonstrated project management experience, including leading cross-functional initiatives and managing timelines and deliverables.
• Risk adjustment certification(s) preferred.

Responsibilities

• Executing a comprehensive risk adjustment strategy that supports health care systems and physicians participating in value-based care contracts.
• Developing a comprehensive risk adjustment strategy aligned with organizational goals and value-based contract requirements to providers.
• Implementing market-specific risk adjustment initiatives to maximize performance and outcomes with assigned physician groups.
• Driving execution of key risk adjustment deliverables, ensuring alignment with quality, compliance, and financial objectives.
• Monitoring performance metrics and trends related to risk adjustment and provider coding accuracy.
• Partnering with physicians, health systems, vendors and internal partners to improve documentation, coding accuracy, and compliance.
• Supporting provider education and engagement initiatives related to risk adjustment and clinical documentation improvement.
• Ensuring timely delivery of assigned projects, meeting defined scope, quality, and performance outcomes.
• Tracking progress, manage risks, and escalate issues as needed.
• Understanding market specific provider performance and provider data impacts to downstream operational, financial & compliance results; identifies issues and works collaboratively to proactively address/design and remediate when needed.

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level