Lead Director, Medicare Risk Adjustment Analytics & AI

CVS Health; Maryland; Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Bonus potential

Equity awards

Comprehensive benefits

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 guide a team of data professionals to improve risk score accuracy and regulatory compliance while delivering measurable business impact.

Reporting to executive leadership, you will partner across finance, operations, and clinical teams to translate complex analytics into actionable strategies.

Qualifications

• 10+ years of experience in healthcare analytics, informatics, risk adjustment, finance, data science, or related fields.
• 2+ years of leadership experience with direct reports.
• Advanced proficiency in SQL, SAS, Python, BigQuery or similar.
• Experience with predictive analytics, ML, financial modeling, or data science concepts.
• Ability to influence leadership and deliver measurable business results.

Responsibilities

• Lead analytics for risk adjustment and performance across Medicare/ACA programs.
• Oversee development of predictive models and AI solutions to support operations and strategy.
• Partner with executives, finance, clinical ops and vendors to drive data-informed decisions.
• Ensure regulatory compliance and data governance across analytics initiatives.
• Mentor a team of analytics, informatics, and data science professionals.

Skills

Healthcare analytics

Leadership

SQL

SAS

Python

BigQuery

Machine learning

Data science

Education

Bachelor's degree

Master's degree

Tools

SQL

SAS

Python

BigQuery

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 guide a team of data professionals to improve risk score accuracy and regulatory compliance while delivering measurable business impact.

Reporting to executive leadership, you will partner across finance, operations, and clinical teams to translate complex analytics into actionable strategies.