Medicaid Risk Adjustment Market Senior Manager
4062 Aetna Resources, LLCWe’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 Senior 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 Senior 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 territory and market-level meetings, oversee a team of managers responsible for delivering market engagement, facilitate tactical working sessions to process next steps, translate performance data into actionable insights, and collaborate with cross-functional partners to advance claims denial resolution, provider engagement opportunities, and member outcomes.
Required Qualifications
5+ years of business, operations, project management, or program management experience.
3+ years of experience managing cross-functional initiatives, deliverables, timelines, and stakeholder follow-up.
2+ years of experience in Medicaid, health care operations, risk adjustment, revenue integrity, claims, provider engagement, or related health care programs.
Demonstrated experience using data, dashboards, reports, or performance metrics to identify opportunities and support business decisions.
Demonstrated experience preparing and presenting business updates or recommendations to leadership or cross-functional stakeholders.
Demonstrated experience facilitating meetings or working sessions with defined action items, owners, and timelines.
Preferred Qualifications
Critical thinking skills
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.
Thinks and acts strategically – Anticipates opportunities and challenges.
Drives long-term strategies while maintaining focus on shorter-term objectives.
Skilled at relationship building to foster effective working relations across the teams, including functional and divisional leaders.
Ability to thrive in a fast-paced, highly visible role with competing priorities.
Excellent communication skills with a demonstrated ability to present effectively to executive leadership.
Strong analytical and problem-solving skills.
Proven ability to lead projects end to end.
Demonstrated ability to lead, coach, and develop managers while driving team accountability, prioritization, and execution across multiple markets.
EDUCATION:
Bachelor’s degree in Finance, Health Care Administration (required or 3 plus years of relevant work experience in lieu of degree). Previous work in Risk Adjustment and/or Medicaid and certification preferred.
Pay Range
The typical pay range for this role is:
$75,400.00 - $165,954.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.