Director of Medicare Risk Adjustment Analytics & AI

CVS Health; Arkansas; Hybrid; USD 120,000 - 232,000; Full time

Benefits offered by this job

Bonus eligibility

Equity awards

Job summary

CVS Health is seeking a Lead Director of Informatics to guide Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. You will lead a team of data professionals and collaborate with executives to drive risk score accuracy and financial insights.

The role sits within Revenue Integrity Informatics and involves cross-functional partnerships with finance, compliance and operations, with potential remote/US-wide placement.

Qualifications

• 10+ years of experience in healthcare analytics, informatics, risk adjustment, actuarial, finance, data science, or related disciplines.
• 2+ years of leadership experience (direct reports, team lead).
• Advanced technical 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.
• Leverage claims and clinical data for deep learning into drivers of performance and model impacts.
• Proactively engage with stakeholders on emerging trends, rising risk, and data-driven opportunities.
• Oversee the analytics that drive risk adjustment intervention activities, including prospective and retrospective programs.
• Directs the prioritization and performance evaluation of outreach, engagement, and clinical documentation initiatives.

Skills

Healthcare analytics

Leadership

Predictive analytics

Data science concepts

Education

Bachelor's degree or equivalent

Master's degree in related field preferred

Tools

SQL

SAS

Python

BigQuery

Job description

CVS Health is seeking a Lead Director of Informatics to guide Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. You will lead a team of data professionals and collaborate with executives to drive risk score accuracy and financial insights.

The role sits within Revenue Integrity Informatics and involves cross-functional partnerships with finance, compliance and operations, with potential remote/US-wide placement.