Medicare Risk Adjustment Senior Manager

Job DescriptionDo you want to make a large impact in your next role? Join Aetna/CVS Health as the Medicare Risk Adjustment Senior Manager, where you will be responsible for leading Risk Adjustment for the Georgia & the Gulf States Medicare Market (GA, LA, MS, AL). You will maintain and improve risk adjustment accuracy for all contracts in multiple states by partnering closely with leadership from our key matrix partners from Network Operations, Sales, Service Operations, Marketing, pharmacy, and the enterprise Risk Adjustment team. In collaboration with the National Risk Adjustment teams, you will drive risk coding improvement activities within the region, medical record collection, provider collaboration and data sharing, general coding education and related activities. To be successful, you will use your ability to think strategically and act independently when working with providers. This position reports to the Lead Director of Risk Adjustment for the Georgia & the Gulf States Medicare Market (GA, LA, MS, AL).This position must be located in-market (GA, LA, MS, AL) and able to meet with provider groups in-person approximately 2-3x/month.The idea candidate will (have): Successfully manage ambiguity and work in fast paced environment Ability to organize and manage multiple priorities Excellent stakeholder relationship management skills Strong time management, project management, change management, organizational, research, analytical, negotiation, communication, and interpersonal skills Strong proficiency in Microsoft Office applications (Outlook, Word, Excel, Power Point, etc.), including experience running web based meetings.Pay RangeThe typical pay range for this role is:Minimum: 75,400Maximum: 158,300Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications 7+ years of work experience required (graduate level education may substitute) 5+ years in risk adjustment, Medicare operations, clinical quality, or healthcare quality improvement Experience working in provider offices or interfacing with providers, accountable care organizations or value-based provider relations Certification in coding (CPC, CRC, RHIA, etc. through AAPC or AHIMA) Leadership experience, either leading latterly/indirectly or with formal direct reports Travel up to 20% required.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Experience in management consulting, project consulting, business process consulting, financial strategic analysis, mergers and acquisitions, strategic business planning, and/or risk management consulting. Experience with business process, project management and organizational redesign experience. Demonstrated experience successfully implementing change in complex organizations.EducationBachelor's degree or equivalent work experience.Masters degree preferred.Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-15