Manager, Risk Adjustment Informatics

Job not on LinkedIn

🔥 19 hours ago

☕ Washington – Remote

☕ Washington – Remote

💵 $66.3k - $145.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🎲 Risk

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Develop, enhance, automate, and maintain standardized monthly program evaluation and KPI reporting using claims, enrollment, diagnosis, provider, and risk adjustment data • Develop and maintain member-level risk adjustment datasets, risk score files, and analytical outputs for Medicare Advantage and ACA programs • Maintain, validate, enhance, and document CMS risk adjustment models in Python and Databricks • Design, develop, and maintain cloud-based datasets, automated data pipelines, and analytical infrastructure within Google Cloud Platform, BigQuery, Databricks, AWS, and Python environments • Develop, automate, and streamline processes for sharing risk adjustment valuation data, reporting outputs, and reference datasets • Lead and support migration of analytic processes and data assets from SAS to cloud-based solutions • Monitor data quality, identify root causes of issues, and implement sustainable solutions with stakeholders • Own and support recurring monthly and ad hoc production processes, including monitoring, quality control, troubleshooting, issue resolution, and documentation • Maintain and improve reference datasets, business rules, and metadata supporting risk adjustment models, valuation processes, KPI reporting, and program analytics • Partner with Informatics, Revenue Integrity, Actuarial, PMO, Data Engineering, and other stakeholders to gather requirements and deliver scalable analytical solutions • Research and respond to complex ad hoc questions related to risk adjustment program performance, valuation methodologies, and healthcare financial outcomes

🎯 Requirements

• 5+ years of experience in healthcare analytics, data management, data engineering, reporting, or business analytics • 3+ years of experience writing complex SQL queries in cloud-based environments such as BigQuery, Databricks, AWS, or similar platforms • Experience developing and supporting automated reporting, production processes, or data pipelines • Experience using GitHub or other source control tools to manage code repositories and version control • Experience working with healthcare claims, enrollment, provider, diagnosis, finance, or risk adjustment data • Ability to communicate technical concepts to technical and non-technical stakeholders • Experience leading or supporting large-scale modernization and migration initiatives • 3+ years of experience with Python, SAS, or equivalent data engineering/analytics programming languages • Experience with Medicare Advantage and/or ACA Risk Adjustment • Experience implementing, maintaining, validating, or reconciling CMS risk adjustment models • Experience developing and maintaining member-level healthcare datasets or other large-scale healthcare data assets • Experience with healthcare valuation, medical economics, risk adjustment economics, provider performance measurement, or healthcare finance concepts • Bachelor's degree in Analytics, Informatics, Statistics, Mathematics, Computer Science, Healthcare Administration, Economics, Finance, or equivalent work experience

🏖️ Benefits

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