Senior Director, Medicaid Risk Adjustment Analytics

Hispanic Alliance for Career Enhancement; Virginia (MN); Hybrid; USD 100,000 - 231,540; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Job summary

CVS Health is recruiting a senior leader to direct Medicaid risk adjustment analytics, reporting, and informatics. This role provides strategic and operational leadership to ensure accurate revenue capture across markets and plans.

You will oversee risk score integrity, data pipelines, and advanced analytics, while guiding a multidisciplinary team and aligning initiatives with regulatory requirements. A Bachelor’s degree and 10+ years in healthcare analytics are preferred.

Qualifications

• 10+ years in healthcare analytics and reporting with claims.
• 3+ years in people leadership roles.
• Advanced technical skills in SAS, SQL, Python, or cloud-based analytics platforms.
• Expertise in Medicaid risk adjustment methodologies and encounter data processes.
• Strong knowledge of risk models (CDPS, CRG, HCC) and state reconciliation processes.
• Proven ability to lead strategic initiatives that deliver measurable outcomes.
• Experience with data visualization tools such as Tableau, Power BI, QuickSight or Looker.

Responsibilities

• Define and execute Medicaid risk adjustment strategy across markets and plans.
• Oversee analytics and reporting to improve revenue accuracy and compliance.
• Lead development of scalable data pipelines and reporting frameworks.
• Ensure readiness for audits and robust data validation practices.
• Direct a multidisciplinary team spanning informatics, risk analytics, and operations.

Skills

Healthcare analytics

Leadership

SAS

SQL

Python

Cloud analytics

Data visualization

Education

Bachelor's degree

Tools

Tableau

Power BI

QuickSight

Looker

Job description

CVS Health is recruiting a senior leader to direct Medicaid risk adjustment analytics, reporting, and informatics. This role provides strategic and operational leadership to ensure accurate revenue capture across markets and plans.

You will oversee risk score integrity, data pipelines, and advanced analytics, while guiding a multidisciplinary team and aligning initiatives with regulatory requirements. A Bachelor’s degree and 10+ years in healthcare analytics are preferred.