Senior Manager Revenue Integrity, Provider Performance (Northeast Territory)
CVSHealth
Remote
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.
**Ideal candidate will sit in the Northeast Region**
**This is an individual contributor**
The Senior Manager, Revenue Integrity, Provider Optimization & Enablement is responsible for executing a comprehensive risk adjustment strategy that supports health care systems and physicians participating in value-based care contracts. Develops a comprehensive risk adjustment strategy aligned with organizational goals and value-based contract requirements to providers. Implements market-specific risk adjustment initiatives to maximize performance and outcomes with assigned physician groups. Drives execution of key risk adjustment deliverables, ensuring alignment with quality, compliance, and financial objectives. Monitor performance metrics and trends related to risk adjustment and provider coding accuracy. Partners with physicians, health systems, vendors and internal partners to improve documentation, coding accuracy, and compliance. Support provider education and engagement initiatives related to risk adjustment and clinical documentation improvement. Ensure timely delivery of assigned projects, meeting defined scope, quality, and performance outcomes. Track progress, manage risks, and escalate issues as needed. Understands market specific provider performance and provider data impacts to downstream operational, financial & compliance results; identifies issues and works collaboratively to proactively address/design and remediate when needed.
Required Qualifications
Minimum of seven (7) years of experience supporting Medicare, Medicaid, and/or ACA health plans.
Demonstrated experience in Medicare and/or Medicaid risk adjustment, value-based care models, provider performance, or population health initiatives.
Working knowledge of both prospective and retrospective programs.
Preferred Qualifications
Demonstrated project management experience, including leading cross-functional initiatives and managing timelines and deliverables.
Risk adjustment certification(s) preferred.
Education
Bachelor's degree preferred or a combination of work experience and education.
Pay Range
The typical pay range for this role is:
$67,900.00 - $199,144.00
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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.