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.
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Health coverage includes medical, dental, and vision with HSA-eligible options, free preventive care, virtual care, and access to MinuteClinic services. Mental-health resources such as counseling support are emphasized, and coverage is often considered solid for full-time colleagues.
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Retirement Support — A dollar-for-dollar 401(k) match up to 5% after one year and an Employee Stock Purchase Plan are consistently highlighted in Total Rewards materials. Feedback suggests retirement programs are a meaningful strength within the overall package.
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Wellbeing & Lifestyle Benefits — Wellbeing offerings include up to 20 no-cost counseling sessions per issue, backup care, tuition assistance, and substantial in-store discounts, alongside broader wellness tools. These everyday perks expand value beyond base pay and can be especially meaningful for full-time schedules.
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What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
