Lead Director, Medicare Risk Adjustment & AI Analytics

Hispanic Alliance for Career Enhancement; New York (NY); Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Competitive compensation package

Comprehensive benefits

Equity targeting and bonus programs

Job summary

CVS Health is seeking a Lead Director, Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and strategic data initiatives. This high-visibility role will drive risk score accuracy, regulatory compliance, and actionable opportunities across the enterprise.

This role may sit anywhere in the US and requires partnering with senior management to shape analytics architecture, automation, and data-driven strategies that improve financial and operational

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.
• Preferred knowledge of Medicare, Medicaid, ACA risk adjustment methodologies, HCC models, and CMS regulatory requirements.

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.
• Oversee analytics that drive risk adjustment intervention activities and governance.
• Direct prioritization and performance evaluation of outreach and documentation initiatives.
• Partner with executives and clinical teams to support strategic planning and performance improvement.

Skills

Risk adjustment

Leadership

Data science

SQL / SAS / Python

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 to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and strategic data initiatives. This high-visibility role will drive risk score accuracy, regulatory compliance, and actionable opportunities across the enterprise.

This role may sit anywhere in the US and requires partnering with senior management to shape analytics architecture, automation, and data-driven strategies that improve financial and operational