Medicaid Risk Adjustment Market Manager

Position Summary 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. We are seeking a highly motivated and strategic professional to serve as the Medicaid Market 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 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 meetings with health plan executives and territory presidents, bringing actionable and important insights that inform decisions, address barriers, and support risk adjustment performance. Key Responsibilities Market Lead & Performance Management 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. Lead territory meetings for health plan executives and territory presidents, bringing forward timely insights, priorities, and recommendations to support risk adjustment initiatives. Lead working groups with provider engagement, network, and quality partners to determine the support required to advance risk adjustment initiatives. Apply project management skills to coordinate deliverables, track timelines, and manage competing priorities. Data Analysis & Reporting 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. Strategy & Execution 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. Required Qualifications 5+ years of experience developing and delivering executive presentations (e.g., monthly/quarterly performance reviews) to senior leaders and cross functional audiences. 2+ years experience of health insurance regulatory and contractual requirements. Demonstrated experience leading recurring territory meetings with health plan executives and territory presidents by presenting actionable insights, capturing decisions, assigning owners, documenting due dates, and driving closure within agreed timelines. Demonstrated ability to independently research, gather, and validate information from multiples sources with minimal direction. Advanced proficiency in Microsoft PowerPoint with 3+ years producing executive-ready decks that translate analytics into clear recommendations (charts, tables, storyline, and summary slides). Proven ability to lead projects end-to-end, including defining scope, building project plans, and delivering milestones on time (e.g., 3+ years owning cross-functional initiatives with documented schedules, RAID logs, and status reporting). Ability to translate complex data into concise actionable insights using visuals and structured storytelling. Ensures rigorous follow up on takeaways, driving accountability and timely completion of next steps across stakeholders. Maintains organized tracking of deliverables, action plans, and project milestones to ensure progress and visibility. Effectively manages multiple priorities in a fast-paced, dynamic environment, adapting quickly to shifting business needs. Exhibits strong attention to detail and organizational skills to support high-quality execution. Collaborates cross-functionally with provider engagement, network, quality, and operations partners to align objectives, define required support, and advance risk adjustment priorities. Proactively identifies risks, gaps, and dependencies, escalating as appropriate and proposing solutions. 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. Preferred Qualifications Experience delivering presentations to Senior Executives and Provider groups Master’s degree or management development program preferred. 2+ years of experience in Medicaid operations, risk adjustment, or medical coding and documentation Deep knowledge of local markets across Aetna Medicaid. Education Bachelor’s Degree or equivalent work experience Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $54,300.00 - $145,860.00 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. Benefits Comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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. 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. Application Deadline We anticipate the application window for this opening will close on: 10/31/2026 Equal Employment Opportunity Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Company Culture Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area. #J-18808-Ljbffr 4062 Aetna Resources, LLC