Job Title

Job DescriptionThe Executive Director, Medicaid Revenue Integrity provides cross-functional leadership across the Medicaid business to drive resolution of revenue integrity items. The position is responsible for all activities across the Medicaid revenue integrity processes related to risk adjustment (RA) focused on complete and accurate diagnosis capture and reporting. Through partnership with local Market teams and appropriate governance processes, the position will ensure initiatives are optimized across the functions and there is consistency among health plans to maximize revenue opportunities. The Executive Director will be focused on leadership, strategy, and data analysis to drive projects that will optimize operations to support complete and accurate risk adjustment results for Medicaid. The position will report to the VP, Revenue Integrity.Responsibilities include (but not limited to):- Responsible for planning and execution of strategies and partnerships to achieve planned margins and growth for the entire segment.- Lead cross-functional initiatives by working with functional leaders to establish revenue integrity goals to support and meet the Medicaid revenue and strategic growth goals. - In conjunction with cross-functional leadership, develops, aligns, and implements processes to drive resolution of revenue integrity opportunities.- Drives innovation by challenging the status quo and driving continuous improvement of processes and outcomes around risk adjustment.- Develops best practices and utilizes appropriate technologies to improve performance.- Create measurable objectives and key results (quarterly, annual, and long-range road map) to provide actionable insights targeting revenue integrity and its impact on the Medicaid organization.- Prioritize leadership requests and provide consistent visibility and dialogue to ensure alignment across project activity.Required Qualifications- Minimum 10 plus years of relevant managed healthcare, operations, and analytical experience that includes Medicaid risk adjustment.- Minimum 5 plus years of team management experience.- Demonstrated/proven operations leadership within a multi-functional matrixed organization.- Strong planning, financial and analytical skills; proven ability to apply these skills with business acumen to handle complex situations with competing priorities.- Proven expertise in developing revenue integrity initiatives to drive overall business growth.- A high degree of organizational awareness and understanding of change management.- Experience building/overseeing business cases and financial models; ability to perform analysis on and uncover insights from data; ability to oversee projects of this nature.- Proven ability to collaborate and effectively manage cross-functional teams.- Demonstrated influence, negotiation, and conflict resolution skills, including the ability to influence and align without clear reporting authority.- Demonstrated ability to craft content, edit effectively and present complex issues and projects succinctly, logically, and persuasively.- Competency in strategic thinking and leadership with strong relationship management skills.- Ability to diagnose project performance problems and execute effective corrective actions.- Advanced knowledge of project management methods plus demonstrated success in delivering complex projects on time/within budget.COVID RequirementsCOVID-19 Vaccination RequirementCVS 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.Preferred QualificationsSee above.EducationBachelors degrees or equivalent. Advanced degree will be valued.Business OverviewBring your heart to CVS HealthEvery 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.