Lead Director, Medicare Risk & ACA Analytics

Hispanic Alliance for Career Enhancement; California (MO); Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Bonus program

Equity awards

Comprehensive benefits

Job summary

CVS Health is seeking a Lead Director, Informatics within Revenue Integrity Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy.

This senior role influences strategic decisions with senior management, drives risk score accuracy, and partners with data engineering to advance architecture and automation. The role may sit anywhere in the US and offers a comprehensive benefits package.

Qualifications

• 10+ years of experience in healthcare analytics, informatics, risk adjustment, or related fields.
• 2+ years of leadership experience with direct reports.
• Advanced technical proficiency in SQL, SAS, Python, BigQuery, or similar.
• Experience with predictive analytics, ML, or data science concepts.
• Ability to influence leadership and deliver measurable business results.
• Knowledge of Medicare/ACA risk adjustment methodologies is a plus.

Responsibilities

• Lead risk adjustment analytics supporting score completeness and accuracy.
• Oversee development of predictive analytics and AI solutions.
• Partner with stakeholders to translate findings into actionable business insights.
• Drive compliance with CMS regulations and data governance.
• Lead a team of analytics, informatics, and data science professionals.

Skills

Healthcare analytics

Leadership

SQL

SAS

Python

BigQuery

Data science concepts

Communication with leadership

Education

Bachelor's degree or equivalent

Master's degree preferred

Tools

SQL

SAS

Python

BigQuery

Job description

CVS Health is seeking a Lead Director, Informatics within Revenue Integrity Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy.

This senior role influences strategic decisions with senior management, drives risk score accuracy, and partners with data engineering to advance architecture and automation. The role may sit anywhere in the US and offers a comprehensive benefits package.