Lead Director, Medicare Risk & ACA Analytics

Texas Health Institute; Town of Texas (WI); Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Bonus eligibility

Equity awards

Comprehensive benefits

Job summary

CVS Health is seeking a Lead Director of Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. You will drive risk score accuracy, regulatory compliance, and enterprise-ready data insights for strategic decisions.

The role leads a multi-disciplinary team and collaborates with executive leadership, finance, and vendor partners, with flexibility to sit anywhere in the US and deliver measurable business impact.

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.
• Develop and implement advanced predictive analytics and AI solutions for risk adjustment and performance.
• Partner with executive leadership and cross-functional teams to support strategic planning and performance improvement.
• Ensure compliance with CMS regulations and data governance while promoting data integrity and auditability.
• Lead and develop a high-performing analytics and informatics team across disciplines.

Skills

Leadership experience

Stakeholder communication

Analytical thinking

Project management

Influence leadership

Education

Bachelor's degree

Master's degree preferred

Tools

SQL

SAS

Python

BigQuery

Job description

CVS Health is seeking a Lead Director of Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. You will drive risk score accuracy, regulatory compliance, and enterprise-ready data insights for strategic decisions.

The role leads a multi-disciplinary team and collaborates with executive leadership, finance, and vendor partners, with flexibility to sit anywhere in the US and deliver measurable business impact.