Healthcare Medicaid Risk Adjustment Analytics, Senior Manager Remote
About The Position
CVS Health has an exciting opportunity for a Senior Informatics Manager to join our dynamic Risk Adjustment Analytics team! In this role, you will lead and execute complex data analyses to drive health plan-level risk adjustment performance through data-driven insights and analytical leadership. This position manages a small team (1-2 employees) responsible for designing and delivering advanced analytics, interpreting large healthcare datasets, and translating findings into actionable strategies that improve quality outcomes and financial performance. The role partners across finance, actuary, and analytics teams to support health plan and enterprise initiatives while ensuring alignment with state Medicaid and CMS regulatory requirements.
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
Nice To Haves
- Experience with risk adjustment methodologies and performance analytics
- Knowledge of CMS and state Medicaid data, reporting, and compliance requirements
- Experience with data visualization tools (e.g., Tableau, Power BI)
Responsibilities
- 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
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
