Medicaid Risk Adjustment Program Management Lead Director

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. Position Summary 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. This role leads strategic program execution, performance management, and data-driven decision-making to ensure complete, accurate, and compliant revenue capture in a highly matrixed environment. As a senior leader within the Revenue Integrity Center of Excellence (RI CoE), this role partners closely with enterprise, regional, and market stakeholders to identify performance risks, implement scalable solutions, and improve outcomes across Medicaid markets. The Lead Director plays a critical role in advancing performance office governance, optimizing program effectiveness, and ensuring alignment with enterprise revenue integrity strategy. This position requires a results-oriented leader with deep Medicaid expertise, strong analytical capabilities, and the ability to drive cross-functional alignment in a complex, regulated environment. Key Responsibilities 1. Program Leadership & Governance (45%) Lead executive and performance governance forums to proactively identify risks and performance gaps impacting revenue integrity outcomes. Design, implement, and continuously refine national Medicaid RI programs aligned to enterprise strategy and regulatory requirements. Partner with RI CoE leaders, clinical leadership, and network organizations to strengthen program effectiveness and drive measurable outcomes. Establish scalable processes, workflows, and operational frameworks to support program execution and sustainability. Lead and deliver high-impact strategic initiatives that improve revenue accuracy, compliance, and overall performance. 2. Performance Analytics & Reporting (20%) Partner with Informatics, Technology, and Performance Office teams to develop and operationalize robust performance reporting. Define and monitor key performance indicators (KPIs), leading indicators, and dashboards to drive actionable insights. Synthesize complex data into executive-level insights and recommendations. Ensure data integrity, reporting accuracy, and alignment across systems supporting Medicaid revenue integrity programs. 3. Market Strategy & Performance (25%) Provide strategic leadership and oversight of Medicaid market performance across regions. Collaborate with regional and local leaders to identify risks, remove barriers, and implement targeted interventions. Serve as a trusted advisor to market leadership, driving accountability for revenue integrity performance. Champion adoption of enterprise programs while tailoring strategies to local market dynamics. 4. Talent Leadership & Organizational Development (10%) Lead and develop a high-performing team with clear accountability for outcomes. Set performance expectations aligned with enterprise objectives and foster a culture of continuous improvement and innovation. Coach and mentor team members to build strategic, analytical, and leadership capabilities. Required Qualifications 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. Preferred Qualifications Master's degree (e.g., MBA, MPH) or completion of a management development program. Deep understanding of enterprise Medicaid markets and state-specific regulatory environments. Experience working within a large national health plan or payer organization. Prior experience in a highly matrixed, enterprise-scale organization. Education Bachelor's degree preferred or a combination of professional work experience and education. Pay Range The typical pay range for this role is: $100,000.00 - $231,540.00 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. 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. The 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. We anticipate the application window for this opening will close on: 06/27/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement