Hartford, Connecticut

Job Description
-This is a new analytical position supporting the review of Medicaid Kick payments in the Medicaid line of business, in a very fast paced and dynamic environment with a high performing team and there are high expectations. This contributor is initially responsible for evaluating internal medical costs and associated Medicaid Maternity Kick payments to determine whether CMS has paid CVS for all of the deliveries that have occurred within our membership. As additional topics beyond Kick payments are identified, this position will develop reporting to support these additional SAI opportunities. This new position will combine focused analytical research, financial modeling, and business decision support related to revenue integrity reporting.

-This position is required to fulfill the Enterprise goals of effective revenue management and medical cost leadership in the Medicaid line of business.
-Analyzes and models actionable recommendations to management based on review of medical cost data and CMS reporting.
-Collaborates with Medicaid management on SAI opportunities related to Kick payments from CMS.
-Participates in research-related activities including industry best practices and experience studies.
-This contributor will work with Senior Leadership representing CVS Health to external constituents. Recognize matters that materially affect financial results and drive sound, unbiased actions on these matters.

-This analytical resource must provide Senior Leadership findings related to Medicaid Kick payments and revenue integrity reporting.

-Analyzes the Medicaid book of business reviewing membership, medical costs related to maternity and revenue received from CMS for those maternity cases.
-This analytical resource must analyze, implement and support delivery of revenue integrity commitments for Medicaid
-This analytical resource is required to work cross-functionally across a diverse stakeholder group including, but not limited to, Product, Actuarial, and Medical Economics
-Plans and sets objectives to deliver responsibilities that have a direct effect on the business results within Medicaid.
-Serves as project manager and/or participant on selected project(s).
-Develops information in support of strategic business plans to meet projected requirements of business area.
-Provides very complex programming and analytical support for medical cost trend analysis and strategic planning (such as verifying trends developed by Actuarial team and developing new tools for the regions to analyze medical costs).
-Works cross-functionally throughout the region toward achieving operational targets.
-Presents complex information in a way that multiple levels within an organization can understand and utilize to make appropriate decisions to meet business objectives.
-Assists in development/mentoring of Consultants and Specialists replace with Directs the day to day activity of Consultants and Specialists. Provides leadership as well as mentoring.
-Assists in the creation of development plans and provides input to scorecards.

Required Qualifications
-5 or more years’ experience in managed care contracting and/or analytics with accountability for business results.

-2 or more years of SQL and/or other data query tool experience.

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.
  • If you are 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 within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
-Understanding of internal and external database applications
-Knowledge of Medicaid product
-Bachelor's degree in Business, Finance, or other related field preferred.
-Advanced skills in Excel, MS-Access and Web-based query tools (MCM, data warehouse) is preferred.
-Individual contributor that applies wide-ranging knowledge and experience of own job area within business unit or function, and may have advanced knowledge and practical experience of specific technical areas applied within the context of a similar industry or type of organization
-Advanced communication/presentation skills.
-Ability to learn new technologies strongly encouraged.
-Strong analytical ability and familiarity with financial and healthcare concepts. Demonstrates critical thinking and expresses ideas clearly, concisely and logically. Ability to manage conflicting priorities and multiple projects concurrently. Demonstrates initiative, innovation and a focus on quality in achieving results.

Bachelor's degree required; Preferably in Business, Finance or related field preferred.

Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. See Job Description

Hartford, Connecticut

Continue serving and work with a purpose

As a CVS Health colleague, you'll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone's life, including your own. Learn more about how you can continue serving on your next mission at CVS Health.

Careers for Veterans and Military Spouses


"The military has an ethos that is grounded in purpose-driven service that’s bigger than the individual. The same holds true for us at CVS Health. You can talk to colleagues in any part of our business and they will be able to articulate our company’s purpose. Working here provides an opportunity for service members and military spouses to continue to serve, just in a civvies."

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