Medicaid Risk Adjustment Program Management Lead Director
Not Disclosed•Full-TimeOn-site
location_on690, South 13th Street, Downtown, Boise, Ada County, Idaho, 83702, United States
About CVS Health
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.
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.
About the Role
Reporting to the Executive Director of Revenue Integrity, the Lead Director - Revenue Integrity (Medicaid) serves as a senior leader within the Revenue Integrity Center of Excellence (RI CoE). This role is critical for driving segment-level performance across Medicaid risk adjustment and revenue integrity initiatives in a highly matrixed environment.
As a strategic partner to enterprise, regional, and market stakeholders, you will identify performance risks, implement scalable solutions, and improve outcomes across Medicaid markets. You will play a pivotal role in advancing performance office governance, optimizing program effectiveness, and ensuring alignment with the enterprise revenue integrity strategy. This position requires a results-oriented leader capable of driving cross-functional alignment and making data-driven decisions to ensure complete, accurate, and compliant revenue capture.
Benefits & Culture
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources based on eligibility.
Equal Opportunity
CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.
Work location
Work model: On-site
690, South 13th Street, Downtown, Boise, Ada County, Idaho, 83702, United States
Boise, Idaho
Key Responsibilities
- check_circleLead executive and performance governance forums to identify revenue integrity risks
- check_circleDesign and implement national Medicaid RI programs aligned with enterprise strategy
- check_circlePartner with Informatics and Technology teams to operationalize performance reporting
- check_circleDefine and monitor KPIs and dashboards to drive actionable insights
- check_circleProvide strategic oversight of Medicaid market performance across regions
- check_circleCollaborate with regional leaders to identify risks and implement targeted interventions
- check_circleLead and develop a high-performing team with clear accountability for outcomes
- check_circleCoach and mentor team members to build strategic and analytical capabilities
Requirements
- verified10+ years Medicaid risk adjustment or revenue integrity experience
- verifiedBachelor's degree preferred
- verifiedMaster's degree (MBA, MPH) or management development program preferred
Nice to Have
Master's degree (e.g., MBA, MPH) or completion of a management development program. Deep understanding of enterprise Medicaid markets and state-specific regulatory environments. Experience working within a large national health plan or payer organization. Prior experience in a highly matrixed, enterprise-scale organization.
Benefits & Perks
check_circleMedical, dental, and vision coveragecheck_circlePaid time offcheck_circleRetirement savings optionscheck_circleWellness programs
Similar Job Opportunities
Skills, education and keywords
Skills: Medicaid, Risk Adjustment, Revenue Integrity, Encounter Data Processes, Performance Reporting, Kpi, Dashboards, Data Integrity, Regulatory Requirements.
Education: Master's degree (e.g., MBA, MPH) preferred; Bachelor's degree preferred or equivalent experience.
Frequently asked questions about Medicaid Risk Adjustment Program Management Lead Director at CVS Health
What does a Medicaid Risk Adjustment Program Management Lead Director at CVS Health do?expand_more
In this Medicaid Risk Adjustment Program Management Lead Director at CVS Health role, you will lead executive and performance governance forums to identify revenue integrity risks; design and implement national medicaid ri programs aligned with enterprise strategy; partner with informatics and technology teams to operationalize performance reporting; and define and monitor kpis and dashboards to drive actionable insights.
What are the requirements for this Medicaid Risk Adjustment Program Management Lead Director role?expand_more
CVS Health is looking for candidates who meet the following requirements: 10+ years Medicaid risk adjustment or revenue integrity experience; Bachelor's degree preferred; and Master's degree (MBA, MPH) or management development program preferred.
Where is the Medicaid Risk Adjustment Program Management Lead Director role at CVS Health located?expand_more
Medicaid Risk Adjustment Program Management Lead Director at CVS Health is based in 690, South 13th Street, Downtown, Boise, Ada County, Idaho, 83702, United States. This is a on-site role.
Is this Medicaid Risk Adjustment Program Management Lead Director job remote, hybrid, or on-site?expand_more
CVS Health has listed this Medicaid Risk Adjustment Program Management Lead Director role as on-site.
How much experience is required for this Medicaid Risk Adjustment Program Management Lead Director role?expand_more
Medicaid Risk Adjustment Program Management Lead Director at CVS Health typically requires 10+ years of relevant experience at the lead level.
What skills do you need for the Medicaid Risk Adjustment Program Management Lead Director role at CVS Health?expand_more
Key skills for Medicaid Risk Adjustment Program Management Lead Director at CVS Health include Medicaid; Risk Adjustment; Revenue Integrity; Encounter Data Processes; Performance Reporting; Kpi; Dashboards; and Data Integrity.
What education is required for Medicaid Risk Adjustment Program Management Lead Director at CVS Health?expand_more
Educational requirements for this role: Master's degree (e.g., MBA, MPH) preferred; and Bachelor's degree preferred or equivalent experience.
What category does the Medicaid Risk Adjustment Program Management Lead Director role belong to?expand_more
Medicaid Risk Adjustment Program Management Lead Director at CVS Health is part of the accounting & finance job category on Recrutus.