Senior Director, Medicare Risk Adjustment Informatics

Hispanic Alliance for Career Enhancement; Nevada (IA); Hybrid; USD 100,000 - 232,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus eligible

Job summary

CVS Health is seeking a Lead Director of Informatics to drive Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and financial valuations. This role requires guiding risk score accuracy, regulatory compliance, and delivering data-informed opportunities.

It may sit anywhere in the US. Responsibilities include leading enterprise analytics, leveraging claims and clinical data, and partnering with cross-functional teams to enhance data architecture and

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).
• Advanced technical proficiency in SQL, SAS, Python, BigQuery, or similar.
• Experience with predictive analytics, machine learning, financial modeling, or data science concepts.

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.
• Engage with stakeholders on emerging trends, rising risk, and data-driven opportunities.
• Oversee analytics that drive risk adjustment intervention activities and governance.

Skills

Healthcare analytics

Leadership

Communication

Data science concepts

Education

Bachelor's degree or equivalent professional work experience

Master's degree preferred

Tools

SQL

SAS

Python

BigQuery

Job description

CVS Health is seeking a Lead Director of Informatics to drive Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and financial valuations. This role requires guiding risk score accuracy, regulatory compliance, and delivering data-informed opportunities.

It may sit anywhere in the US. Responsibilities include leading enterprise analytics, leveraging claims and clinical data, and partnering with cross-functional teams to enhance data architecture and