Remote Lead Director, Risk Adjustment Informatics

Hispanic Alliance for Career Enhancement; Wyoming (OH); 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, Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and financial valuations. The role drives risk score accuracy, regulatory compliance, and actionable data-informed opportunities, reporting to senior management in a highly visible enterprise-wide capacity.

This full-time position may sit anywhere in the US, offering a competitive benefits package, bonus eligibility and equity opportunities,

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).
• 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.
• Leverage claims and clinical data for deep learning into drivers of performance and model impacts.
• Proactively engage with stakeholders on emerging trends, rising risk, and data-driven opportunities.
• Oversee analytics that drive risk adjustment intervention activities, including prospective and retrospective programs.
• Direct the prioritization and evaluation of outreach, engagement, and clinical documentation initiatives.

Skills

SQL

SAS

Python

BigQuery

Machine learning

Leadership

Education

Bachelor's degree or equivalent

Master's degree in related field

Tools

BigQuery

SAS

Python

Job description

CVS Health is seeking a Lead Director, Informatics to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and financial valuations. The role drives risk score accuracy, regulatory compliance, and actionable data-informed opportunities, reporting to senior management in a highly visible enterprise-wide capacity.

This full-time position may sit anywhere in the US, offering a competitive benefits package, bonus eligibility and equity opportunities,