Senior Manager, Healthcare Medicaid Risk Adjustment Analytics

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🕒 June 25

🥔 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

⚕️ 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 and execute complex data analyses to drive health plan-level risk adjustment performance • Manage a small team of 1–2 employees responsible for advanced analytics • Evaluate health plan performance across Medicaid populations to identify trends, gaps, and opportunities • Design and execute analyses using medical and pharmacy claims, encounter, provider, and membership data • Translate analytical findings into actionable health plan strategies and decision-making • Develop and maintain scalable reporting, dashboards, and performance monitoring tools • Support data models, forecasting approaches, and performance measurement frameworks • Ensure data accuracy, integrity, and governance across reporting and analytics • Identify and implement process improvements through automation and advanced analytics • Communicate complex findings to technical and non-technical stakeholders • Support compliance with CMS and state Medicaid requirements through accurate, timely reporting and analysis • Partner with finance, actuarial, and analytics teams on health plan and enterprise initiatives

🎯 Requirements

• 8+ years of relevant professional experience in healthcare analytics, including claims and encounter data • 2+ years of leadership experience managing, coaching, or mentoring team members • Experience with government-regulated healthcare programs such as Medicaid, Medicare, and/or ACA • Advanced technical skills in Google Cloud Platform (GCP), BigQuery, SQL, SAS, Python, or similar programming languages • Experience with large, complex healthcare datasets and root cause analysis • Ability to manage multiple projects and competing priorities in a fast-paced environment • Ability to translate technical analyses into actionable business insights • Excellent communication skills across technical and non-technical audiences • Experience with risk adjustment methodologies and performance analytics preferred • Knowledge of CMS and state Medicaid data, reporting, and compliance requirements preferred • Experience with data visualization tools such as Tableau or Power BI preferred • Bachelor's degree preferred, or a combination of professional work experience and education

🏖️ 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