Senior Director, Medicaid Risk Adjustment Analytics

Hispanic Alliance for Career Enhancement

Oklahoma

Hybrid

USD 100,000 - 231,540

Full time

14 days+

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Job summary

CVS Health is seeking a Lead Director for Revenue Integrity Informatics (Medicaid) to lead Medicaid risk adjustment analytics, reporting, and informatics, ensuring accurate revenue capture across markets and plans.

The role requires 10+ years in healthcare analytics, 3+ years of leadership, and mastery of SAS/SQL/Python and modern data platforms; you’ll drive strategic initiatives, build scalable data pipelines, and align risk models with state requirements to optimize revenue and compliance.

Qualifications

10+ years of experience in healthcare analytics and reporting, risk adjustment including claims.
3+ years of leadership experience including people managing, coaching, or mentoring team members.
Advanced technical skills in SAS, SQL, Python, or cloud-based analytics platforms (e.g. BigQuery, Snowflake, Databricks).
Expertise in state and regulatory requirements, risk adjustment methodologies, and encounter data processes.
Strong knowledge of risk models (CDPS, CRG, HCC) and state reconciliation processes.
Proven ability to develop and execute strategic initiatives that deliver measurable business outcomes.
Demonstrated leadership experience managing cross-functional teams and large-scale programs.
Experience with data visualization tools (Tableau, Power BI, QuickSight, Looker).

Responsibilities

Define Medicaid risk adjustment strategy across markets and plans.
Lead high-impact strategic initiatives to improve revenue accuracy and compliance.
Align programs with state Medicaid models and communicate outcomes to executives.
Oversee analytics and reporting using claims, encounters, pharmacy, and clinical data.
Lead reconciliation of plan scores to state-reported scores and monitor data quality.