At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary
Leads team to develop enterprise-wide and/or cross-functional solutions to address business problems, resulting in initiatives that significantly impact organizational strategy, enabling the organization to be competitive in the marketplace and effectively serve its customers. Collaborates across the organization to optimize the achievement of strategic business objectives to include profitable growth and improved organizational effectiveness.Strong understanding of CMS regulations, HEDIS, STAR ratings, risk adjustment, and provider engagement strategies. Demonstrates ability to analyze financial and quality performance data and implement process improvements.
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Required Qualifications
- Advises management through strategic business consultation to support the organization's goals and objectives.
- Defines processes and assignments for researching, collecting, analyzing, and compiling data and information for the business consulting department reports.
- Develops and implements processes for auditing files, reports, and financial records, to assure security and compliance with relevant laws and regulations.
- Communicates with top management regarding business operations and market trends by providing analysis and recommending solutions.
- Communicates strategically internally and externally with clients, and senior management regarding the goals and objectives of the business.
- Counsels the internal and external department point of contact ensuring concise communication with employees, stakeholders, and members of the senior management.
- Advises management regarding current business trends and best practices preparing analysis for senior management, stakeholders, and clients.
- Controls all systems for performance appraisals within the business consulting department ensuring compliance and continuous improvement.
- Administers strategic review processes ensuring continuous improvement, compliance, and high-performance standards are upheld.
- Minimum 10+ years of experience in healthcare quality, risk adjustment, revenue integrity, or compliance within a Medicare Advantage setting.
Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), Certified Professional in Healthcare Quality (CPHQ).
Education
Bachelor's degree in Health Administration, Business Finance or a related field or equivalent experience.Pay Range
The typical pay range for this role is:$100,000.00 - $231,540.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.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.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.