[Remote] Sr. Manager Business Consulting - Risk Adjustment at CVS Health

Florida City, Florida, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Expertise in Risk Adjustment payment models for MA, ACA and Medicaid
Expertise in Risk Adjustment timelines and requirements
Ability 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
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:
Experience with 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
Education: Bachelor Degree or equivalent experience required
Other Certification(s): CPC-P; PAHM, CPM - Preferred

Responsibilities

Manage vendor performance to achieve volume and quality goals each year
Work independently to implement new programs and/or vendors or new services within the existing program and vendors
Cross-departmental project planning to implement new programs and/or vendors or new services
Meet internal market and product customers' needs
Evaluate data and translate information into action or project plans
Influence others in diverse departments and markets to support Prospective Programs
Contribute to the development and implementation of business strategies
Collaborate with internal teams to achieve business objectives
Develop and maintain relationships with internal stakeholders and external vendors
Meet performance targets and achieve business objectives
Provide recommendations to Executive Leadership on business issues and support recommendations to the Executive Leadership
Communicate complex business issues and support recommendations to Executive Leadership

Skills

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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