Senior Director, Medicare Risk Adjustment Analytics & AI

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

Job summary

CVS Health seeks a Lead Director, Informatics to guide Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. You will drive risk score accuracy, regulatory compliance, and data-informed opportunities across the enterprise.

This senior role may sit anywhere in the US and requires 10+ years in healthcare analytics, with strong leadership and advanced SQL/SAS/Python expertise.

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 tools.
• 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 performance evaluation of outreach, engagement, and clinical documentation initiatives.
• Lead the development and implementation of advanced predictive analytics and AI solutions to support risk adjustment, population health, and business performance initiatives.
• Drive innovation through automation, advanced analytics, and emerging technologies that improve efficiency and scalability.
• Measure and evaluate intervention effectiveness and overall business impact.
• Translate complex analytical findings into practical recommendations that improve operational, clinical, and financial outcomes.
• Partner with technology and data engineering teams to enhance data architecture, automation, and analytics capabilities.

Skills

SQL

SAS

Python

BigQuery

Predictive analytics

Machine learning

Financial modeling

Data science concepts

Leadership

Education

Bachelor's degree or equivalent professional work experience

Master's degree in a related field

Job description

CVS Health seeks a Lead Director, Informatics to guide Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and intervention strategy. You will drive risk score accuracy, regulatory compliance, and data-informed opportunities across the enterprise.

This senior role may sit anywhere in the US and requires 10+ years in healthcare analytics, with strong leadership and advanced SQL/SAS/Python expertise.