Sr. Manager Business Consulting - Risk Adjustment

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary

The Purpose of the Sr. Manager, Business Consultation job is to drive prospective program volume and quality of performance. Revenue Integrity Prospective Programs drives revenue for the Enterprise. The colleague in this role will work independently to manage vendor performance to achieve volume and quality goals each year while also meeting the needs of Revenue Integrity's internal market and product customers. This role includes cross-departmental project planning to implement new programs and/or vendors or new services within the existing program and vendors.Required Qualifications:

• Expertise in Risk Adjustment payment models for MA, ACA and Medicaid.
• Expertise in Risk Adjustment timelines and requirements
• Must be able to sit for long periods of time performing computer work.
• Some travel may be required to meet in person with internal Aetna customers or external vendors.
• Colleague must have extensive experience with Microsoft Office -Excel, Word, PowerPoint, Teams, SharePoint
• Expert communication skills both written and verbal.
• Ability to concisely explain complex business issues and support recommendations to Executive Leadership
• Ability to evaluate data and translate information into action or project plans.
• Ability to influence others in diverse departments and markets to support Prospective Programs.
• Ability to pivot and be flexible in a fast-paced changing regulatory environment
• Work full time hours between normal business times 7am-5pm and occasionally later hours to accommodate vendors and market customers in other time zones.

Preferred Qualifications

• Prefer Colleague has some experience in query tools such as SQL, SAS, Python, R+
• Experience with Project Management tools including Microsoft Project or Asana.
• Certified Coding Certification such as CPC-P, CRC or AHIMA is preferred.
• Project Management or Six Sigma certification is preferred

EducationBachelor Degree or equivalent experience required

Other Certification(s): CPC-P; PAHM, CPM - PreferredPay Range

The typical pay range for this role is:$67,900.00 - $149,328.00

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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 10/18/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Client-provided location(s): Sebring, FL

Job ID: CVS-R0730222

Employment Type: FULL_TIME

Posted: 2025-10-01T19:48:54