State Lead - Medicaid Risk Adjustment Market Manager

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.

• 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.

• Work closely with the Informatics team to review requirements, dashboards, reports including any enhancements.
• Utilise 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.

• 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…