Remote Lead Director Medicare Risk Adjustment Informatics

Hispanic Alliance for Career Enhancement; Washington; Hybrid; USD 100,000 - 232,000; Full time

Job summary

CVS Health is seeking a Lead Director of Informatics to guide Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. You will lead analytics to improve risk score accuracy, regulatory compliance, and financial valuation while partnering with senior management across the enterprise.

The role may sit anywhere in the US and requires extensive healthcare analytics leadership, strong SQL/SAS/Python expertise, and a track record of delivering measurable

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 score completeness, accuracy, engagement, recapture, and algorithms.
• Develop and implement advanced predictive analytics and AI solutions to support risk adjustment, population health, and business performance initiatives.
• Partner with executive leadership to support strategic planning and performance improvement efforts.
• Build and mentor a high-performing analytics and informatics team across related disciplines.
• Ensure data governance, CMS regulatory compliance, and robust controls for data integrity.

Skills

Healthcare analytics

Leadership

Predictive analytics

Machine learning

Data modeling

Influence leadership

Education

Bachelor's degree or equivalent professional work experience

Master's degree in Business, Informatics, Analytics, Finance, Statistics, Computer Science, Public Health, Healthcare analytics, Actuarial, Mathematics, Economics, or equivalent

Tools

SQL

SAS

Python

BigQuery

Job description

CVS Health is seeking a Lead Director of Informatics to guide Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. You will lead analytics to improve risk score accuracy, regulatory compliance, and financial valuation while partnering with senior management across the enterprise.

The role may sit anywhere in the US and requires extensive healthcare analytics leadership, strong SQL/SAS/Python expertise, and a track record of delivering measurable