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Job Details

CVS Health

Senior Business Consultant - Commercial Risk Adjustment



Full Time

On Site


California, United States

Job Description
Management professional to develop and implement strategies and policies to direct our Small Group Risk Adjustor resources. They help our business units – and our company – meet corporate objectives and compete more successfully in the marketplace.

They support Commercial team as a resource accountable for ensuring provider relationships perform optimally with regards to Risk Adjustment, documentation and specificity.

They will be tasked to:
- Develop and support holistic solutions and/or key strategic plans to improve performance
- Work across market leadership to establish and champion a local market culture committed to Risk Adjustment excellence
- Act as the face of Revenue Integrity externally with providers and manage internal and external stakeholder relationships critical to the Revenue integrity (RI) environment
- Identify and execute upon local market Risk Adjustment strategies
- Drive key initiatives and transfer knowledge, best practices, methodology and tools to stakeholders
- Manage and direct local vendors when appropriate
- Conduct data analysis using national tools in conjunction with the corporate lead to identify opportunity areas and paths on track; assure member metrics met
- Evaluate provider group performance to prioritize Risk Adjustment initiatives; develop strategy on which members/Value Based Providers
- Engage with clinical team and specific clinics, medical groups, hospitals; attend JOC meetings and facilitate work sessions; support engagement managers and RN program managers using a disciplined repeatable methodology
- Support local market colleagues in ensuring strategic and optimal bids; attend/host trainings
- Partner closely with other business units, such as product, sales, network, clinical, and medical economics
- Share joint accountability for initiative return on investment

Pay Range
The typical pay range for this role is:
Minimum: 75,400
Maximum: 162,700

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.

Required Qualifications
- Experience with Microsoft Office products (Word, Excel, Project, PowerPoint, Outlook)
- Experience with ICD-10 codes
- Experience with Risk Adjustment processes
- Prior employment at a health plan, provider group, or equivalent experience
- Experience with moderate scale initiatives with moderate degree of complexity

Preferred Qualifications
5+ years experience with CA Small Group risk adjustor methodology tools and resources.

College degree preferred or equivalent work experience. Appropriate licensure or certification by discipline preferred as well.

Business Overview
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.