Medicaid Risk Adjustment Program Management Lead Director

at CVS Health in Boise, Idaho, United States Job Description 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. Position Summary Reporting to the Executive Director of Revenue Integrity (RI), the Lead Director
• Revenue Integrity (Medicaid) is responsible for driving segment-level performance across Medicaid risk adjustment and revenue integrity initiatives.

This role leads strategic program execution, performance management, and data-driven decision-making to ensure complete, accurate, and compliant revenue capture in a highly matrixed environment. As a senior leader within the Revenue Integrity Center of Excellence (RI CoE), this role partners closely with enterprise, regional, and market stakeholders to identify performance risks, implement scalable solutions, and improve outcomes across Medicaid markets. The Lead Director plays a critical role in advancing performance office governance, optimizing program effectiveness, and ensuring alignment with enterprise revenue integrity strategy. This position requires a results-oriented leader with deep Medicaid expertise, strong analytical capabilities, and the ability to drive cross-functional alignment in a complex, regulated environment. Key Responsibilities 1. Program Leadership & Governance (45%) + Lead executive and performance governance forums to proactively identify risks and performance gaps impacting revenue integrity outcomes. + Design, implement, and continuously refine national Medicaid RI programs aligned to enterprise strategy and regulatory requirements. + Partner with RI CoE leaders, clinical leadership, and network organizations to strengthen program effectiveness and drive measurable outcomes. + Establish scalable processes, workflows, and operational frameworks to support program execution and sustainability. + Lead and deliver high-impact strategic initiatives that improve revenue accuracy, compliance, and overall performance. 2. Performance Analytics & Reporting (20%) + Partner with Informatics, Technology, and Performance Office teams to develop and operationalize robust performance reporting. + Define and monitor key performance ind To view full details and how to apply, please login or create a Job Seeker account