Medicaid Risk Adjustment Lead Director

CVS Health

Lead Director for Medicaid revenue integrity and risk adjustment initiatives at CVS Health. Driving segment-level performance, program execution, and data-driven decision-making with senior leadership.

Posted 5/28/2026full-timeConnecticut, Idaho, Texas • 🇺🇸 United StatesSenior💰 $100,000 - $231,540 per yearWebsite

About the role

Key responsibilities & impact

Reporting to the Executive Director of Revenue Integrity (RI), the Lead Director – Revenue Integrity (Medicaid) is responsible for driving segment-level performance across Medicaid risk adjustment and revenue integrity initiatives.
Leads strategic program execution, performance management, and data-driven decision-making to ensure complete, accurate, and compliant revenue capture in a highly matrixed environment.
Partners closely with enterprise, regional, and market stakeholders to identify performance risks, implement scalable solutions, and improve outcomes across Medicaid markets.
Plays a critical role in advancing performance office governance, optimizing program effectiveness, and ensuring alignment with enterprise revenue integrity strategy.

Requirements

What you’ll need

A minimum of 10 years of experience in Medicaid risk adjustment / revenue integrity
Demonstrated expertise in Medicaid regulatory requirements, including risk adjustment methodologies and encounter data processes
Proven ability to develop and execute strategic initiatives that deliver measurable business outcomes
Strong leadership capabilities with advanced problem-solving and decision-making skills in complex, matrixed environments
Experience leading large-scale, cross-functional programs with significant enterprise-wide impact
Skilled at influencing senior stakeholders and driving change within highly regulated environments
Consistent attendance and flexibility to travel as required.

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

Medicaid risk adjustmentrevenue integrityrisk adjustment methodologiesencounter data processesstrategic program executionperformance managementdata-driven decision-makingprogram effectiveness

Soft Skills

leadershipproblem-solvingdecision-makinginfluencing stakeholdersdriving changeflexibility