Lead Director, Medicare & ACA Risk Adjustment Informatics

Hispanic Alliance for Career Enhancement; West Virginia; 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 guide Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategies. The role drives risk score accuracy, regulatory compliance, and data-driven opportunities, with high visibility to senior management.

This role may sit anywhere in the US and will oversee analytics, AI initiatives, and partnerships with data engineering to enhance data architecture and efficiency.

Qualifications

• 10+ years of experience in healthcare analytics, informatics, risk adjustment, or related fields.
• 2+ years of leadership experience (direct reports).
• Advanced proficiency in SQL, SAS, Python, and BigQuery or similar.
• Experience with predictive analytics, ML, financial modeling, or data science concepts.

Responsibilities

• Lead enterprise risk adjustment analytics for score completeness and accuracy.
• Develop and implement predictive analytics and AI solutions for risk adjustment and population health.
• Translate findings into practical recommendations for operational and financial improvements.
• Partner with tech and data teams to enhance data architecture and analytics capabilities.
• Provide executive-level insights and influence strategic investment decisions.

Skills

Healthcare analytics

Leadership

SQL

Machine learning

Data visualization

Education

Bachelor's degree or equivalent

Master's degree preferred

Tools

BigQuery

SAS

Python

Job description

CVS Health is seeking a Lead Director, Informatics to guide Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategies. The role drives risk score accuracy, regulatory compliance, and data-driven opportunities, with high visibility to senior management.

This role may sit anywhere in the US and will oversee analytics, AI initiatives, and partnerships with data engineering to enhance data architecture and efficiency.