Senior Director, Medicaid Risk Adjustment Analytics & Insights

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

Benefits offered by this job

Medical, dental, vision coverage

Retirement savings options

Wellness programs

Paid time off

Job summary

CVS Health is seeking a Lead Director for Revenue Integrity Informatics (Medicaid) to provide strategic and operational leadership for Medicaid risk adjustment analytics, reporting, and informatics. In this senior role, you will guide state methodology alignment, build scalable data pipelines, ensure data integrity, and partner with actuarial and finance teams to connect risk scores to payments.

You will manage a multidisciplinary team, drive governance, and deliver measurable business outcomes

Qualifications

• 10+ years of experience in healthcare analytics and reporting, risk adjustment including relevant working knowledge with 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, or similar)
• Expertise in state and regulatory requirements, risk adjustment methodologies, and encounter data processes
• Strong knowledge of risk models (e.g., 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 (e.g. Tableau, Power BI, QuickSight, Looker, etc.).

Responsibilities

• Define Medicaid risk adjustment strategy across markets and plans
• Oversee health plan performance using advanced analytics and data pipelines for reporting
• Lead reconciliation of plan‑calculated risk scores to state‑reported scores and audits readiness
• Lead program insights and KPIs, align data strategies with value‑based initiatives
• Lead and develop a multidisciplinary analytics and operations team across markets

Skills

Strategic leadership

Healthcare analytics

Leadership experience

Cross-functional collaboration

Data visualization

Risk adjustment knowledge

Project management

Education

Bachelor's degree

Master's degree

Tools

SAS

SQL

Python

BigQuery

Snowflake

Databricks

Tableau

Power BI

Looker

Job description

CVS Health is seeking a Lead Director for Revenue Integrity Informatics (Medicaid) to provide strategic and operational leadership for Medicaid risk adjustment analytics, reporting, and informatics. In this senior role, you will guide state methodology alignment, build scalable data pipelines, ensure data integrity, and partner with actuarial and finance teams to connect risk scores to payments.

You will manage a multidisciplinary team, drive governance, and deliver measurable business outcomes