Director, Medicare Risk Adjustment Analytics & AI

CVS Health; Missouri; Hybrid; USD 100,000 - 232,000; Full time

Job summary

CVS Health is seeking a Lead Director of Informatics to guide Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and strategic intervention. You will manage a team of analytics leaders to deliver data-driven opportunities, improve risk score accuracy, and support enterprise decision-making.

The role collaborates with executive leadership, finance, operations, compliance, and vendor partners to translate complex findings into actionable recommendations and measurable

Qualifications

• 10+ years of healthcare analytics, informatics, risk adjustment, actuarial, finance, data science, or related disciplines.
• 2+ years of leadership experience (direct reports).
• Advanced proficiency in SQL, SAS, Python, BigQuery, or similar.
• Experience with predictive analytics, machine learning, financial modeling, or data science concepts.
• Demonstrated ability to influence leadership and deliver measurable business results.

Responsibilities

• Lead enterprise risk adjustment analytics supporting risk score completeness, accuracy, engagement, recapture, and algorithms.
• Develop and implement advanced predictive analytics and AI solutions to support risk adjustment, population health, and business performance initiatives.
• Partner with executive leadership, market leaders, finance, actuarial, service operations, and clinical teams to support strategic planning and performance improvement efforts.
• Ensure adherence to CMS regulations, data governance policies, and organizational compliance expectations.
• Lead, mentor, and develop a high-performing team of leaders and individual contributors across analytics, informatics, data science, and related disciplines.
• Provide executive-level presentations and recommendations that influence organizational strategy and investment decisions.

Skills

SQL

SAS

Python

BigQuery

Leadership

Predictive analytics

Machine learning

Education

Bachelor's degree or equivalent

Master's degree in relevant field

Tools

BigQuery

Job description

CVS Health is seeking a Lead Director of Informatics to guide Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and strategic intervention. You will manage a team of analytics leaders to deliver data-driven opportunities, improve risk score accuracy, and support enterprise decision-making.

The role collaborates with executive leadership, finance, operations, compliance, and vendor partners to translate complex findings into actionable recommendations and measurable