Lead Director, Risk Adjustment Performance Reporting, Insights

Job not on LinkedIn

🔥 1 hour ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $100k - $231.5k / year

⏰ Full Time

🟠 Senior

🎲 Risk

👻 Ghost score 0%

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Lead development and delivery of enterprise risk adjustment analytics and business intelligence solutions • Transform clinical, operational, and risk adjustment data into actionable insights for provider performance, program efficiency, and executive decision-making • Create action through data storytelling, advanced visualizations, AI, and automation • Provide thought leadership and vision partnership to Market leads, Finance, Clinical, and Operational partners • Provide technical guidance on BI tool input modeling and calculations • Share risk adjustment KPIs, trends, and performance drivers through dashboards and reporting tools • Quantify risk movement drivers and surface insights to business leaders • Assess performance against objectives through benchmarking and goal setting • Deliver executive insights and recommendations supporting market strategy, operational planning, and performance improvement • Develop and oversee provider performance analytics for gap closure, engagement, and risk adjustment outcomes • Monitor provider performance metrics, trends, opportunities, and best practices across markets, specialties, and lines of business • Partner with provider, clinical, and operational leaders on performance improvement initiatives and targeted interventions • Evaluate provider-facing risk adjustment programs, value-based care, point-of-care enablement solutions, and clinical and operational initiatives • Lead adoption of AI, advanced analytics, automation, and modern BI capabilities • Modernize analytics platforms, data solutions, and self-service reporting tools • Use predictive analytics and data visualization to improve insight generation and forecasting • Partner with Informatics, Data Engineering, and IT teams on scalable analytics solutions • Establish KPI definitions, governance standards, and an enterprise analytics framework • Oversee analytics delivery priorities, intake management, work prioritization, resource allocation, and coordination • Lead, mentor, and develop an analytics and business intelligence team of approximately 4–5 direct reports and 7–8 employees overall • Partner with executive leaders across Risk Adjustment, Finance, Actuarial, Clinical, Provider, and IT organizations • Foster accountability, innovation, collaboration, and continuous learning

🎯 Requirements

• 10+ years of healthcare analytics, informatics, performance insights, actuarial, value-based, or business intelligence experience • 2+ years of leadership experience managing analytics, reporting, or business intelligence • Strong executive communication, strategic thinking, stakeholder management, and team development skills • Advanced experience with programming languages such as SQL and Python • Advanced experience with BI platforms such as Power BI, Tableau, and QuickSight • Proven ability to lead complex analytics portfolios, establish priorities, and maintain organization in developer code and processes • Knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements preferred • Experience at a health plan or provider system preferred • Bachelor’s degree or equivalent professional work experience • Master’s degree or equivalent advanced education, professional certification, or demonstrated subject matter expertise preferred

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program • Equity award program

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