Description
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. *Position Summary* We have an outstanding opportunity for an enthusiastic team player to lead local market Medicaid Provider Engagement risk adjustment initiatives across the Aetna Better Health Plans. Reporting to the Provider Engagement Lead Director of Medicaid Risk Adjustment Provider Engagement , the Manager will work closely with cross-functional leadership across the Medicaid business to establish and champion local market culture committed to revenue integrity excellence. This position requires a strong affinity for understanding and presenting to large audiences and candidate must have the ability to deal effectively with a diverse group of providers and stakeholders to drive complete and accurate diagnosis capture. Through partnership with local market teams and appropriate governance processes, this position will ensure initiatives are optimized across functions and are consistent among health plans. This position is responsible for implementing and optimizing provider engagement initiatives for all Aetna Medicaid Health Plans, executing comprehensive strategies aimed at fostering meaningful collaborations with healthcare providers and aligning the Medicaid Risk Adjustment initiatives to broader Aetna Medicaid Health Plan goals. This position will be responsible for implementing and overseeing collaborative efforts with healthcare provider groups in the context of Medicaid risk adjustment. This position involves developing and executing strategic initiatives to optimize engagement, communication, and understanding between the Aetna and external healthcare partners. This position requires a dynamic leader with a strategic mindset, strong interpersonal skills, and a deep understanding of Medicaid regulations and risk adjustment methodologies. *Strong preference for this position to be hybrid, within a commutable distance to a CVS/Aetna Hub Office (i.e. Hartford, CT, Lansing, MI, Scottsdale, AZ, Miami, FL, Woonsocket, RI, Chicago, IL, Dallas, TX, Boston, MA, etc.) Primary Responsibilities % Time *Market Support & Performance Management 30%* * Engage with clinical team and specific clinics, medical groups, hospitals; attends JOC meetings; Support engagement managers and RN program managers. * Assist with implementation of VBCs and/or other key provider group arrangements. Work with the markets to direct provider interventions and assists physicians and office staff who perform below set metrics/expectations. * Collaborate with other departments within the organization to ensure key provider reimbursement methodologies and provisions are administratively supported. * Lead the development and implementation of provider education strategies and action plans through monitoring provider performance. * Establish and champion local market culture committed to revenue integrity and excellence. * Partner with other Revenue Integrity program leads to monitor and drive high quality outcomes. * Manage and direct local vendors when appropriate. *Strategy & Execution* 25% * Identify and develop market level risk adjustment strategies to strengthen Medicaid risk score performance. * Ensure Risk Adjustment programs are aligned with local market strategies to drive risk score performance completely and accurately in a timely manner. * Jointly identify provider prioritization strategies for risk score improvement initiatives including identifying and deploying customized provider trainings and solutions to support provider groups as necessary. * Develop and deploy innovative member engagement programs with the goal of assessing member health risk and address member care needs to achieve better health outcomes. * Develops processes, workflows, and other materials to document the operational and strategic components of program initiatives. * Ensure progress against strategy and priorities through the tracking and reporting of measurable outcomes, and propose innovative solutions to emerging issues. * Navigate a complex, multi-stakeholder environment. * Build and evaluate financial models and develop executive-level presentations with supporting material to successfully align on strategy objectives. *Data Analysis & Reporting* 25% * Work closely with the Informatics team to review requirements, dashboards, and reports, and propose enhancements as necessary. * Conduct data analyses using available tools in partnership with the business partners to identify areas of opportunity. * Produce and present dashboards specific to Medicaid Revenue Integrity efforts at various governance, market, and executive leadership meetings. * Investigates operational issues that impact market performance – work with business partners to implement solutions. *Leadership and Innovation* 20% * Stay abreast of regulatory changes and leading risk adjustment practices and tools to maximize the effectiveness and efficiency of the team. * Partner 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. * Actively participate in key projects impacting Medicaid Revenue Integrity efforts. * Mentor the team in stakeholder facilitations, communications, and relationship management. *Required Qualifications: * 5+ years of professional healthcare experience required including some combination of: - Experience in risk adjustment, medical coding, and documentation - Experience in provider engagement strategies *Preferred Qualifications* 2+ years in of Medicaid risk adjustment Knowledge of insurance regulatory and contractual requirements. Knowledge of value-based provider contract/agreements. Project management and program management background preferred. Deep knowledge of local markets across Aetna Medicaid. Experience working in a highly matrixed environment. Previous experience working for a large national carrier. *Education* Bachelor's degree or equivalent experience. Master's degree in Finance, Health Administration or MBA preferred *Pay Range* The typical pay range for this role is: $63,300.00 - $139,200.00This 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](https://jobs.cvshealth.com/benefits) We anticipate the application window for this opening will close on: 04/26/2024
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