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CVS Health

Senior Manager Business Consultant Risk Adjustment- Remote U.S.

Remote

Job Description
The Revenue Integrity (RI) Lead Business Consultant is part of the Revenue Integrity Market Engagement Organization (RI ME). The Lead Business Consultant is responsible for the management and monitoring a designated market/territory specific to the performance of risk adjustment (RA). The role is responsible for all aspects of driving collaborative decision-making and implementation of corporate, regional and local actions to maximize RA activities and initiatives for the designated market/territory. Specifically, the Lead Business Consultant will be responsible for increasing market level engagement, collaboration, and accountability by bridging the gap between RI National and Market level resources to drive RAF results.



RI ME is part of the RI Compliance Organization, residing officially within the Revenue Integrity Center of Excellence (RI COE). As a whole, RI COE drives integrated strategy, investments, analytics, decision support, intervention programs and performance management across the enterprise to achieve complete, accurate, and compliant risk adjustment documentation and reporting for all LOBs. Optimizing business performance in the risk adjustment space is a foundational element of the organization's mission.

RI ME works closely with key business stakeholders to develop innovative ways to achieve enterprise risk adjustment (RA) performance goals across all markets. Lead Business Consultants drive development of corporate, local and cross-functional solutions to address business problems and ensure the achievement of strategic RI and RA objectives. Lead Business Consultants are accountable for performance by market and will be responsible for concurrent initiatives as a team lead and/or team member. RI COE is in place to drive risk adjustment business performance leveraging stakeholders that reside across the entire enterprise. Optimizing business performance in the risk adjustment space is a foundational element of the organization's mission.

Individuals applying should have a demonstrated, results-driven background, and enjoy working autonomously in highly regulated, data-driven, action-oriented environment. It is critical this candidate is dedicated to evaluating performance on an ongoing basis This highly visible role collaborates with corporate, regional and local health plan leaders on a daily basis.

Key Responsibilities:
- Lead regular meetings with Markets to review strategy, goals, and performance holistically
- Bring together national program leads and markets to calibrate interventions in response to unique market challenges and opportunities
- Manages the development and implementation of corporate performance improvement campaigns and initiatives as needed
- Share and promote best practices amongst market colleagues
- Ensure data and reporting needs (Market Scorecard, RAD, & Supporting Data Sources) are being met to inform decisions, drive action, and measure success locally
- Utilize objective data and local knowledge to create and track market specific action plans
- Develops and delivers solutions that drive sustainable operating efficiency
- Provides oversight and direction to markets
- Provides oversight, direction and consultative support to corporate, regional, local resources around RI programs at the National and local market level to drive strategy and make impact with our RA activities
- Other responsibilities deemed necessary as deemed by the department leadership

Pay Range
The typical pay range for this role is:
Minimum: 75,400
Maximum: 162,700

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit
jobs.CVSHealth.com/benefits

Required Qualifications
- 3-5 years of experience in risk adjustment
- 3-5 years in Management
- Demonstrates a deep understanding of the Medicare business, customers, and clients.
- Knowledge of insurance regulatory and contractual requirements.
- Knowledge of value-based provider contract/agreements.
- Self-starter who demonstrates initiative and displays a high energy level
- Thinks and acts strategically - Anticipates opportunities and challenges and drives long-term strategies while maintaining focus on shorter-term objectives.
- Highly developed relationship building and influencing skills to foster effective working relations across the teams, including functional and divisional leaders.
- Powerful communications skills and awareness of audience to properly convey information in a meaningful, yet concise manner.
- Intellectual curiosity and tenacity: strong ability to learn on the fly; to understand and solve complex problems.
- Analytical rigor: proven capability conducting and managing quantitative analysis with the highest level of attention to detail.

Preferred Qualifications
- Deep knowledge of local markets across Aetna Medicare.
- Extensive data analytics experience

Education
- Master's degree or management development program preferred.
- Bachelor's degree and 6+ years of relevant work experience required.

Business Overview
Bring your heart to CVS Health Every 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. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Job ID: CVS-2418433BR_73035715
Employment Type: Other

This job is no longer available.

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