Senior Director, Medicare Risk Adjustment Analytics & AI

ISHE; Northern (KY); Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus eligibility

Equity opportunity

Job summary

CVS Health is seeking a Lead Director of Informatics in Revenue Integrity to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and regulatory compliance.

You will manage a team of about 5 directs, collaborate with senior leaders, and partner with finance, actuarial, and IT to drive data-informed opportunities and measurable business impact across the enterprise.

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.
• 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 the analytics that drive risk adjustment intervention activities, including prospective and retrospective programs.
• Directs 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

Leadership

SQL

SAS

Python

BigQuery

Machine Learning

Data Analytics

Risk Adjustment

Healthcare Analytics

Influence Leadership

Education

Bachelor's degree

Master's degree in relevant field

Tools

SAS

SQL

Python

BigQuery

Job description

CVS Health is seeking a Lead Director of Informatics in Revenue Integrity to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, and regulatory compliance.

You will manage a team of about 5 directs, collaborate with senior leaders, and partner with finance, actuarial, and IT to drive data-informed opportunities and measurable business impact across the enterprise.