Informatics Manager - Risk Adjustment

CVS Health•Hartford, CT

About The Position

The Informatics Manager supports the strategy, oversight, and valuation of vendors serving Medicare and Medicaid risk adjustment programs. The role evaluates vendor capabilities and performance, develops financial and return-on-investment analyses, and uses data to forecast revenue impact and identify risks and opportunities. It partners with business, technical, and regional stakeholders to translate risk adjustment requirements into vendor solutions, governance routines, and performance measures. The position presents valuation findings, recommendations, and escalation items to senior leaders, promoting compliant, accountable, and analytically driven decision-making. The role supports vendor strategy, selection, contracting, onboarding, performance management, and issue resolution. It develops vendor valuation methodologies and scorecards, oversees data, reporting, and analytics, and translates program requirements into business, data, and technology specifications. It also develops and executes analytics and AI-enabled capabilities, maintains documentation, and reports findings to senior leaders and governance forums.

Requirements

At least 3 years of relevant experience in healthcare analytics, risk adjustment, vendor management, financial analysis, or an equivalent combination of experience.
Working knowledge of Medicare Advantage, Medicare Part D, Medicaid, and state-specific risk adjustment programs.
At least 2 years of experience with SQL and/or Python for data analysis, validation, reconciliation, and performance measurement.
At least 2 years of experience with business intelligence reporting tools such as Amazon Quick, Tableau, or Power BI.
Strong problem-solving, decision-making, planning, execution, collaboration, and stakeholder management skills.

Nice To Haves

Experience with Medicare Advantage, Part D, Medicaid, or state risk adjustment models, data submissions, reconciliation, and revenue forecasting.
Experience evaluating and managing risk adjustment vendor performance.
Experience developing vendor valuations, financial forecasts, sensitivity analyses, and return-on-investment assessments.
Experience with contract performance measures, procurement processes, vendor scorecards, and executive governance.
Experience using governed analytics or AI-enabled capabilities to improve risk adjustment operations, valuation, or vendor oversight.
Experience with cloud platforms such as Amazon Web Services (AWS) and Google Cloud Platform (GCP).
Experience working with Databricks to query data, develop analysis, and deploy dashboards.
Bachelor's degree preferred, or specialized training/relevant professional qualification.

Responsibilities

Support vendor strategy, selection, contracting, onboarding, performance management, and issue resolution for Medicare and Medicaid risk adjustment programs.
Develop and maintain vendor valuation methodologies that quantify financial opportunity, return on investment, operational impact, and performance against contractual commitments.
Evaluate vendor capabilities, data quality, coding accuracy, submission readiness, scalability, and alignment with enterprise risk adjustment objectives.
Establish scorecards, key performance indicators, and governance routines to monitor vendor performance.
Oversee data, reporting, and analytics used to assess risk adjustment performance, forecast revenue impact, reconcile results, and identify emerging opportunities or risks.
Translate Medicare and Medicaid risk adjustment requirements into business, data, and technology specifications for internal teams and external vendors.
Develop, maintain, and execute analytics and AI-enabled capabilities that improve vendor oversight, valuation accuracy, operational efficiency, and decision-making while maintaining accountability.
Design and maintain documentation for vendor processes, data flows, and valuation models.
Present vendor performance, valuation findings, recommendations, and escalation items to senior leaders and governance forums.