Lead Director, Health Risk Assessment

Job DescriptionThis position is fully remote.At CVS Health we are bringing our heart to every moment of your health. The Aetna Duals Segment is rapidly expanding and searching for highly visible leadership position to support and collaborate with Dual markets across the country (including Medicaid-Medicare (MMP) markets) to drive Medicare Risk Adjustment performanceThe Risk Adjustment Director will cultivate key stakeholder relationships across dual markets nationally and will serve as a point person for risk adjustment activities within the duals segment. The Director will collaborate with Medicare market leadership, Duals segment leadership and related corporate teams to facilitate initiatives and work towards improved performance.Key Responsibilities:- Accountable for MRA strategy, performance, and results within duals markets.- Collaborates with Aetna's enterprise Revenue Integrity teams to execute on critical initiatives. - Responsible for identifying nuanced duals local market MRA strategies and working with market teams executing tactics to maximize results. - Develops processes, workflows, and other materials to document the operational and strategic components of initiatives. - Conducts data analysis to identify and prioritize provider outreach opportunities for coding education and MRA initiatives across various markets. - Works with coding educators who engage with local providers to evaluate coding and documentation performance and trends; builds strategies for ongoing improvement. - Leads cross-functional work groups and partners with local and enterprise colleagues from Aetna's Revenue Integrity, Network, and Clinical teams. - Collaborates with Provider Engagement Managers and RN Program Managers to maximize the risk score performance of Aetna's value-based provider partners as applicable in the duals space. - Engages with clinical teams, providers, market teams and serves as a SME on Medicare Risk Adjustment, coding, and documentation. - Collaborates to ensure successful results in medical record retrieval projects, prospective coding programs, provider education initiatives, and dissemination of coding standard methodologies.- Investigates operational issues that impact MRA performance and works with business partners to implement solutions. - Inspires change to improve results and organizational efficiency related to MRA.Pay RangeThe typical pay range for this role is:Minimum: 100,000Maximum: 221,000Please 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 QualificationsRequired Qualifications: - 5+ years of experience in Medicare Risk Adjustment. - Proven success leading, developing, executing change and inspiring teams within a matrix environment- Demonstrated leadership with project management, financial analysis, strategic business planning, and risk management. - Experience with enterprise-wide and or cross-functional large-scale initiatives involving a wide degree of complexity. - Strong analytical skills, with the ability to review and manipulate data to draw conclusions.- Ability to think strategically and to translate strategy into measurable goals. - Proven relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization, as well as with providers and external vendors. - Communication and presentation skills; experience addressing Senior Leadership.- Knowledge of current health care marketplace dynamics- Ability to build relationships with a diverse workforce and cross functional groupsPreferred QualificationsPreferred Qualifications: - Subject matter expertise with revenue integrity programs for special needs and complex populations (DSNP, ISNP, CSNP, FIDE and/or MMP products)- Working knowledge of Medicaid risk adjustment models- Prior experience with LIS and LTSS revenue integrity programs - Prior working relationships with key stakeholders within local communities served by Aetna's Dual products will be valuedEducationEducation: Bachelor's degree in a related field requiredBusiness 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