Medicaid Risk Adjustment Market Manager

CVS Health

Medicaid Market Manager overseeing Risk Adjustment programs at CVS Health. Driving market engagement, performance insights, and value demonstration to senior leaders and partners.

Posted 4/27/2026full-timeRemote • Connecticut, Idaho, Ohio, Texas • 🇺🇸 United StatesMid-LevelSenior💰 $54,300 - $145,860 per yearWebsite

About the role

Key responsibilities & impact

Function as a face of Revenue Integrity across internal market teams
Develop and deliver executive level presentations highlighting key performance drivers, challenges, and solutions
Investigates operational issues that impact market performance – work with business partners to implement solutions
Track deliverables and identify barriers in market engagement in conjunction with implementing resolutions
Assist with development of educational material to support market intelligence
Engage with market clinical team, care management team, member services team; attend market level meetings as appropriate
Apply project management skills to coordinate deliverables, track timelines, and manage competing priorities
Work closely with the Informatics team to review requirements, dashboards, reports including any enhancements
Utilize data analyses using national tools in conjunction with the corporate lead to identify areas of opportunity
Produce and present market specific performance specific to Medicaid Revenue Integrity efforts at various governance, market, and executive leadership meetings
Monitors program or programs that are jointly accountable for risk adjustment strategy, performance, and results within a designated market(s)
Responsible for identifying and recommending nuanced market risk adjustment strategies and collaboratively executing tactics to focus, maximize and achieve market success, including market referrals
Coordinate with local markets to drive correctness, completeness, accuracy, and timeliness of risk score performance
Collaborate on market specific strategies that drive member engagement in risk adjustment programs
Stay abreast of regulatory changes and leading risk adjustment practices and tools to maximize the effectiveness and efficiency of the team
Partner with segment product, sales, network, clinical teams to implement processes aimed at strengthening member and provider engagement of Revenue Integrity programs resulting in improved outcomes

Requirements

What you’ll need

5+ years of progressive experience in healthcare operations, risk adjustment or related fields
2+ years analyzing performance data and building executive-ready narratives and materials that translate findings into clear recommendations (KPIs, trends, variance drivers, and actions)
3+ years leading cross-function projects, managing project plans/timelines and routing status reporting
Strong presentation skills with ability to clearly communicate complex information to diverse audiences, including senior leadership
Proven track record of leading and supporting meetings by capturing detailed, accurate notes, key decisions and action items
Advanced proficiency in Microsoft PowerPoint; including ability to create clear, visually compelling, executive-level presentations
Strong working knowledge of Microsoft Excel, with experience building tables, charts and dashboard to synthesize and communicate data effectively
Ability to translate complex data into concise actionable insights using visuals and structured storytelling
Rigorous follow up on takeaways, driving accountability and timely completion of next steps across stakeholders
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
Proven ability to lead projects end to end

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
other resources, based on eligibility

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

data analysisproject managementperformance data analysisrisk adjustment strategiesexecutive-level presentationsKPI analysisdashboard creationvisual storytellingMicrosoft PowerPointMicrosoft Excel

Soft Skills

presentation skillscommunication skillsinitiativeintellectual curiosityproblem-solvingcollaborationaccountabilityattention to detailleadershiptime management