Lead Director, Healthcare Medicaid Risk Adjustment Analytics

CVS Health

Lead Director providing strategic and operational leadership for Medicaid risk adjustment analytics at CVS Health. Collaborating with teams to ensure compliance and optimize revenue capture.

Posted 7/9/2026full-timeRemote • Connecticut, Idaho, Texas • 🇺🇸 United StatesSenior💰 $100,000 - $231,540 per yearWebsite

Tech Stack

Tools & technologies

BigQueryCloudPythonSQLTableau

About the role

Key responsibilities & impact

Define and execute Medicaid risk adjustment strategy across markets and plans
Lead and deliver high-impact strategic initiatives that improve revenue accuracy, compliance, and overall performance
Align risk adjustment programs with state Medicaid models (e.g., CDPS, CRG, or state-specific methodologies)
Represent risk adjustment Medicaid informatics in executive forums
Oversee health plan performance using advanced analytics and use proactive data insights to drive strategies and evidence-based decision-making
Lead development of scalable data pipelines and reporting frameworks using claims, encounters, pharmacy, and clinical data
Ensure accuracy, integrity and completeness of Medicaid encounter submissions and data
Establish and oversee processes to ensure accuracy, completeness, and integrity of risk capture
Direct suspecting logic development, gap identification, and prioritization strategies for operational programs and interventions
Lead and develop a high-performing, multidisciplinary team spanning informatics, risk analytics, reporting, and operational program support

Requirements

What you’ll need

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.).

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs

ATS Keywords

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Hard Skills & Tools

Healthcare AnalyticsRisk AdjustmentClaims AnalysisData Pipeline DevelopmentAdvanced AnalyticsRisk ModelsEncounter Data ProcessesStrategic Initiative ExecutionData Integrity ManagementProactive Data Insights

Soft Skills

LeadershipCoachingMentoringCross-Functional Team ManagementCommunication