[Hiring] Lead Director, Healthcare Medicaid Risk Adjustment Analytics @CVS Health

Role Description

Revenue Integrity Informatics is seeking a Lead Director - Revenue Integrity Informatics (Medicaid) to join our highly dynamic Risk Adjustment analytics team. This senior-level role will provide strategic and operational leadership for all Medicaid risk adjustment analytics, reporting, and informatics functions to ensure complete, accurate, and compliant revenue capture.

This leader oversees the end-to-end risk adjustment lifecycle, including:

• Data management
• Suspecting
• Analytic insights
• Risk score reconciliation
• Performance monitoring

They partner closely with clinical, actuarial, finance, market plans, and compliance stakeholders to support health plan and enterprise initiatives while ensuring alignment with state Medicaid and CMS regulatory requirements.

The Lead Director should also demonstrate leadership in innovation and adoption of modern technologies, data platforms, machine learning, process automation, AI, and data science for optimized insights, workflows, reporting, and process controls. This role will lead a team of managers and individual contributors with backgrounds in data science, analytics, statistics, data engineering, and informatics.

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.)

Requirements

• Knowledge of Medicaid Risk Adjustment
• Working with Medicaid Risk models
• Master’s degree (e.g., Health Informatics, Data Science, Actuarial, Statistics, or MBA) preferred
• Experience working within a large national health plan or payer organization

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources, based on eligibility

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.