Strategic Director, Medicaid Risk Adjustment Analytics

NHSHP; New Hampshire; On-site; USD 100,000 - 232,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Retirement savings options

Wellness programs

Equity award program

Bonus or incentive program

Job summary

CVS Health seeks a Lead Director for Revenue Integrity Informatics (Medicaid) to guide end-to-end risk adjustment analytics, partnering with clinical, actuarial, finance, and compliance teams to ensure compliant revenue capture across markets.

This senior role leads a multidisciplinary team, drives data platforms and automation, and ensures state Medicaid alignment, audits readiness, and measurable impact on revenue and performance.

Qualifications

• 10+ years of experience in healthcare analytics and reporting, risk adjustment with claims.
• 3+ years of leadership experience including people management.
• Advanced technical skills in SAS, SQL, Python, or cloud analytics platforms.
• Expertise in state and regulatory requirements, risk adjustment methodologies.
• Strong knowledge of risk models (CDPS, CRG, HCC) and state reconciliation.
• Proven ability to develop and execute strategic initiatives with measurable outcomes.
• Demonstrated leadership with cross-functional teams and large programs.
• Experience with data visualization tools (Tableau, Power BI, QuickSight, Looker).

Responsibilities

• Define and execute Medicaid risk adjustment strategy across markets and plans.
• Oversee data pipelines and reporting frameworks using claims, encounters, and clinical data.
• Lead analytics for risk score development, modeling, forecasting, and trend analysis.
• Ensure accuracy, integrity and completeness of Medicaid encounter submissions.
• Direct a multidisciplinary team across informatics, analytics, and operational programs.

Education

Bachelor's degree

Master's degree preferred

Tools

SAS

SQL

Python

BigQuery

Snowflake

Databricks

Tableau

Power BI

Looker

Job description

CVS Health seeks a Lead Director for Revenue Integrity Informatics (Medicaid) to guide end-to-end risk adjustment analytics, partnering with clinical, actuarial, finance, and compliance teams to ensure compliant revenue capture across markets.

This senior role leads a multidisciplinary team, drives data platforms and automation, and ensures state Medicaid alignment, audits readiness, and measurable impact on revenue and performance.