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Job description
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.
nPosition Summary
nWe 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.
nThe 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.
nnMarket Lead & Performance Management
n nnnFunction as a face of Revenue Integrity across internal market teams.
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nnDevelop and deliver executive level presentations highlighting key performance drivers, challenges, and solutions.
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nnInvestigates operational issues that impact market performance – work with business partners to implement solutions.
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nnTrack deliverables and identify barriers in market engagement in conjunction with implementing resolutions.
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nnAssist with development of educational material to support market intelligence.
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nnLead territory meetings for health plan executives and territory presidents, bringing forward timely insights, priorities, and recommendations to support risk adjustment initiatives.
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nnLead working groups with provider engagement, network, and quality partners to determine the support required to advance risk adjustment initiatives.
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nnApply project management skills to coordinate deliverables, track timelines, and manage competing priorities.
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n n2. Data Analysis & Reporting
nnnWork closely with the Informatics team to review requirements, dashboards, reports including any enhancements.
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nnUtilize data analyses using national tools in conjunction with the corporate lead to identify areas of opportunity.
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nnProduce and present market specific performance specific to Medicaid Revenue Integrity efforts at various governance, market, and executive leadership meetings.
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n n3. Strategy & Execution
nnnMonitors program or programs that are jointly accountable for risk adjustment strategy, performance, and results within a designated market(s).
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nnResponsible for identifying and recommending nuanced market risk adjustment strategies and collaboratively executing tactics to focus, maximize and achieve market success, including market referrals.
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nnCoordinate with local markets to drive correctness, completeness, accuracy, and timeliness of risk score performance.
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nnCollaborate on market specific strategies that drive member engagement in risk adjustment programs.
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nnStay abreast of regulatory changes and leading risk adjustment practices and tools to maximize the effectiveness and efficiency of the team.
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nnPartner 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.
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n nRequired Qualifications
nnn5+ years of experience developing and delivering executive presentations (e.g., monthly/quarterly performance reviews) to senior leaders and cross functional audiences.
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nn2+ years experience of health insurance regulatory and contractual requirements.
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nnDemonstrated experience leading recurring territory meetings with health plan executives and territory presidents by presenting actionable insights, capturing decisions, assigning owners, documenting due dates, and driving closure within agreed timelines.
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nnDemonstrated ability to independently research, gather, and validate information from multiples sources with minimal direction.
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nnAdvanced proficiency in Microsoft PowerPoint with 3+ years producing executive-ready decks that translate analytics into clear recommendations (charts, tables, storyline, and summary slides).
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nnProven ability to lead projects end-to-end, including defining scope, building project plans, and delivering milestones on time (e.g., 3+ years owning cross-functional initiatives with documented schedules, RAID logs, and status reporting).
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nnAbility to translate complex data into concise actionable insights using visuals and structured storytelling.
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nnEnsures rigorous follow up on takeaways, driving accountability and timely completion of next steps across stakeholders.
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nnMaintains organized tracking of deliverables, action plans, and project milestones to ensure progress and visibility.
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nnEffectively manages multiple priorities in a fast-paced, dynamic environment, adapting quickly to shifting business needs.
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nnExhibits strong attention to detail and organizational skills to support high-quality execution.
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nnCollaborates cross-functionally with provider engagement, network, quality, and operations partners to align objectives, define required support, and advance risk adjustment priorities.
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nnProactively identifies risks, gaps, and dependencies, escalating as appropriate and proposing solutions.
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nnKnowledge of insurance regulatory and contractual requirements.
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nnSelf-starter who demonstrates initiative and displays a high energy level.
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nnIntellectual curiosity and tenacity: strong ability to learn on the fly; to understand and solve complex problems. Thinks and acts strategically – Anticipates opportunities and challenges.
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n n Preferred Qualifications
nnnExperience delivering presentations to Senior Executives and Provider groups
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nnMaster’s degree or management development program preferred.
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nn2+ years of experience in Medicaid operations, risk adjustment, or medical coding and documentation
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nnDeep knowledge of local markets across Aetna Medicaid.
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n nEducation
nBachelor’s Degree or equivalent work experience
nAnticipated Weekly Hours
n40
nTime Type
nFull time
nPay Range
nThe typical pay range for this role is:
n$54,300.00 - $145,860.00
nThis 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.
nOur 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.
nGreat benefits for great people
nWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
nThis 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.
nAdditional details about available benefits are provided during the application process and on Benefits Moments ( .
nWe anticipate the application window for this opening will close on: 10/31/2026
nQualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
nCVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.
Worksite address
springfield, IL, 62777, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.