Lead Director, Risk Adjustment Performance Reporting, Insights

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🥔 Idaho, Pennsylvania, +1 more states – Remote

🥔 Idaho – Remote 🔔 Pennsylvania – Remote 🤠 Texas – Remote

💵 $100k - $231.5k / year

⏰ Full Time

🟠 Senior

🎲 Risk

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 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 and advanced visualizations • Advance the organization’s reporting strategy through AI and automation • Provide customer-facing thought leadership and vision partnership to Market, 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 • Leverage claims, encounter, and clinical healthcare data to understand outcome drivers • Develop and oversee provider performance analytics for gap closure, engagement, and risk adjustment outcomes • Monitor provider performance metrics and identify variation, trends, opportunities, and best practices • 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 other initiatives • Lead adoption of AI, advanced analytics, automation, and modern business intelligence 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 to build scalable analytics solutions • Establish KPI definitions, governance standards, and an enterprise analytics framework • Oversee analytics delivery priorities, intake management, work prioritization, resource allocation, and stakeholder 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 • 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 • Demonstrated knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements • Experience at a health plan or provider system • Bachelor’s degree or equivalent professional work experience • Master’s degree in a relevant field, advanced education, professional certification, or demonstrated subject matter expertise preferred

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Award target in the company’s equity award program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being