Senior Informatics Manager, Risk Adjustment Analytics

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🔥 0 minutes ago

🥔 Idaho, Massachusetts, +1 more states – Remote

🥔 Idaho – Remote 🍂 Massachusetts – Remote 🤠 Texas – Remote

💵 $67.9k - $199.1k / year

⏰ Full Time

🟠 Senior

🎲 Risk

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

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

• Evaluate health plan performance using advanced analytics to identify trends, gaps, and opportunities across Medicaid populations • Design and execute complex analyses leveraging medical and pharmacy claims, encounter, provider, and membership data • Translate analytical findings into clear, actionable insights to drive health plan strategies and decision-making • Develop and maintain scalable reporting, dashboards, and performance monitoring tools • Support development of data models, forecasting approaches, and performance measurement frameworks • Ensure data accuracy, integrity, and governance across reporting and analytical outputs • Identify and implement process improvements through automation and advanced analytics • Communicate complex findings effectively to both technical and non-technical stakeholders • Support compliance with CMS and state Medicaid requirements through accurate, timely reporting and analysis

🎯 Requirements

• 8+ years of relevant professional experience in healthcare analytics, including working with claims and encounter data • 2+ years of leadership experience managing, coaching, or mentoring team members • Experience with government-regulated healthcare programs (Medicaid, Medicare, and/or ACA) • Advanced technical skills in Google Cloud Platform (GCP)/Big Query, SQL, SAS, Python, or similar programming languages • Demonstrated experience working with large, complex healthcare datasets and performing root cause analysis • Proven ability to manage multiple projects and competing priorities in a fast-paced environment • Strong ability to translate technical analyses into actionable business insights • Excellent communication skills across technical and non-technical audiences

🏖️ Benefits

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