The successful candidate can be located anywhere in the U.S.A.
This position will be a point person for the Medicaid Actuarial team’s involvement with Revenue Integrity, a crucial initiative for the Medicaid Business Unit.
This position’s responsibilities will include (but are not limited to):
- Tracking performance of revenue integrity initiatives and building out the financial business case for newly introduced initiatives.
- Partnering with Medicare informatics to apply a revenue methodology that best forecasts the projected ROI to create chase lists for intervention programs.
- Constructing a database to calculate “should be” Medicaid revenue, which will allow for member-level valuation & prioritization to maximize ROI of revenue integrity efforts.
- Coordinating with Finance teams for risk score and revenue related SAIs.
- Aggregating and assessing risk score and pricing timelines for all Medicaid markets for purposes of initiative prioritization.
7+ years actuarial work experience.
Must be an ASA or FSA and a member of the American Academy of Actuaries able to sign state rate filings and other required actuarial certifications.
Good communication skills and problem solving skills are essential.
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.
Experience in Medicaid, prior work on risk adjustment, and experience with project management is preferred but not required.
A Bachelor’s degree is required.
At Aetna, a CVS Health company, 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 are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.
Clipped from: https://www.glassdoor.com/job-listing/actuarial-director-cred-medicaid-cvs-health-JV_IC1130361_KO0,32_KE33,43.htm?jl=4168748205&utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic