Medicaid Risk Adjustment Market Leader

CVS Health Corporation; Richmond (VA); On-site; USD 54,000 - 146,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus opportunities

Paid time off and wellness programs

Job summary

CVS Health Corporation is seeking a Medicaid Market Manager to drive risk adjustment performance and stakeholder engagement across markets. You will connect national strategy with local execution, presenting insights to senior leaders and coordinating cross-functional teams to optimize outcomes.

The role requires strong project management, data storytelling, and regulatory knowledge, with a focus on driving timely, data-driven decisions and improving member engagement across networks.

Qualifications

• 5+ years of experience delivering executive presentations to senior leaders.
• 2+ years experience with health insurance regulatory requirements.
• Experience leading recurring territory meetings with health plan executives.
• Ability to independently research and validate information from multiple sources.
• Advanced PowerPoint skills with 3+ years creating executive-ready decks.
• Experience leading end-to-end cross-functional projects.
• Ability to translate complex data into concise insights using visuals.
• Strong follow-up, accountability and milestone tracking.
• Collaborates across provider engagement, network, quality, and operations.
• Proactively identifies risks and dependencies, escalating as needed.

Responsibilities

• Represent Revenue Integrity to market teams and executives.
• Deliver executive presentations highlighting performance drivers and solutions.
• Investigate operational issues impacting market performance and implement solutions.
• Track deliverables and address barriers with timely resolutions.
• Develop educational material to support market intelligence.
• Lead territory meetings with health plan executives and presidents.
• Lead working groups with provider engagement, network and quality partners.
• Coordinate deliverables using project management methods.
• Review requirements and dashboards with Informatics; enhance reports.
• Identify opportunities using national data tools and market analytics.
• Present market-specific performance at governance and leadership meetings.
• Monitor risk adjustment strategy and execute tactics across markets.
• Coordinate with local markets to ensure accuracy of risk scores.
• Collaborate on member engagement strategies for risk programs.
• Stay updated on regulatory changes and best practices.
• Partner with product, sales, network and clinical teams to engage members.

Skills

Executive presentations

PowerPoint

Regulatory knowledge

Project management

Risk adjustment

Cross-functional collaboration

Research skills

Data storytelling

Follow-up

Organization

Multitasking

Attention to detail

Strategic thinking

Education

Bachelor's Degree or equivalent work experience

Job description

CVS Health Corporation is seeking a Medicaid Market Manager to drive risk adjustment performance and stakeholder engagement across markets. You will connect national strategy with local execution, presenting insights to senior leaders and coordinating cross-functional teams to optimize outcomes.

The role requires strong project management, data storytelling, and regulatory knowledge, with a focus on driving timely, data-driven decisions and improving member engagement across networks.