Lead Director, Medicare & ACA Risk Adjustment Analytics

Hispanic Alliance for Career Enhancement; Maine; Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Lead Director, Informatics to drive Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. You will lead risk score accuracy, regulatory compliance, and data-informed opportunities across a major enterprise.

This senior role can sit anywhere in the US and requires 10+ years in healthcare analytics, leadership, and strong SQL/SAS/Python/BigQuery capabilities.

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.
• Direct the prioritization and performance evaluation of outreach, engagement, and clinical documentation initiatives.
• Lead the development and implementation of advanced predictive analytics and AI solutions to support risk adjustment, population health, and business performance initiatives.

Skills

SQL

SAS

Python

BigQuery

Education

Bachelor's degree or equivalent professional work experience

Master's degree in relevant field (preferred)

Job description

CVS Health is seeking a Lead Director, Informatics to drive Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. You will lead risk score accuracy, regulatory compliance, and data-informed opportunities across a major enterprise.

This senior role can sit anywhere in the US and requires 10+ years in healthcare analytics, leadership, and strong SQL/SAS/Python/BigQuery capabilities.