This role is responsible for leading Risk Adjustment for the Great Lakes and is aligned to the Mid America Territory of the United States. This role will have responsibility in maintaining and improving risk adjustment accuracy for all contracts in multiple states by partnering closely with leadership from our key matrix partners from Network Operations, Sales, Service Operations, Marketing, pharmacy, and the enterprise Risk Adjustment team. The role drives, in collaboration with the National Risk Adjustment, risk coding improvement activities within the region, medical record collection, vendor management, provider collaboration and data sharing, general coding education and related activities, as well as other activities as assigned.
This position requires someone who can think strategically and act independently when working with providers. This position reports to the Great Lakes Lead Director of Risk Adjustment.
- Strategic partner to regional and national teams. Build excellent relationships with market leaders and network operations leaders within this region, attend local market meetings where Risk adjustment is under discussion and support strategic direction and consultation services.
- Implement market or region specific strategies that will lead to quality improvements and increased Risk Adjustment accuracy.
- Support programs that drive Risk adjustment accuracy improvements in all Great Lakes plans, including managing vendors engaging with members and providers.
- Implementation of Risk Adjustment coding accuracy improvement activities within the region to drive improvement in patient care, quality of care and health outcomes.
- Partner with the National Risk Adjustment team to improve the health outcomes of our membership through care of our members and improve coding accuracy thru innovative initiatives that drive improved data collection and incremental process improvements.
- Implement projects and initiatives designed to impact performance and ensure compliance, which will include leading activities with matrixed partners.
- Work collaboratively with Stars and Risk Adjustment leadership to identify best practices within the region, and scale them over the enterprise.
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
- Experience with moderate scale initiatives with moderate degree of complexity.
- 3+ years of risk adjustment, clinical quality, or healthcare quality improvement leadership experience required
- 5+ years experience with one or more of the following methodologies: management consulting, project consulting, business process consulting,
financial strategic analysis, mergers and acquisitions, strategic business planning, and/or risk management consulting
- Strong time management, project management, organizational, research, analytical, negotiation, communication, and interpersonal skills
- Strong proficiency in Microsoft Office applications (Outlook, Word, Excel, Power Point, etc.), including experience running web based meetings.
- Demonstrated ability to lead people and get results through others
- Must be able to manage ambiguity and work in fast paced environment
- Ability to organize and manage multiple priorities
- Excellent stakeholder relationship management skills
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
- 5+ years of risk adjustment, clinical quality, or healthcare quality improvement experience
- Bachelor's degree highly desired, or equivalent work experience.
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.
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