Lead Director, Risk Adjustment Performance Reporting and Insights

This is a fully remote position, open to applicants in Alabama, +43 more states.

📋 Description

• Spearhead the creation and execution of enterprise risk adjustment analytics and business intelligence solutions.

• Convert clinical, operational, and risk adjustment data into practical insights for enhancing provider performance, program efficiency, and executive decision-making.

• Generate action through compelling data storytelling, sophisticated visualizations, AI, and automation.

• Provide visionary thought leadership and partnership to Market leads, Finance, Clinical, and Operational teams.

• Offer technical direction on BI tool input modeling and calculations.

• Present risk adjustment KPIs, trends, and performance drivers via dashboards and reporting tools.

• Identify risk movement drivers and present insights to business leaders.

• Evaluate performance against objectives through benchmarking and goal setting.

• Deliver executive insights and recommendations that support market strategy, operational planning, and performance enhancement.

• Develop and manage provider performance analytics focused on gap closure, engagement, and risk adjustment outcomes.

• Track provider performance metrics, variations, trends, opportunities, and best practices.

• Collaborate with provider, clinical, and operational leaders on performance improvement initiatives and targeted interventions.

• Assess provider-facing risk adjustment programs, value-based care, point-of-care enablement solutions, and other initiatives.

• Champion the integration of AI, advanced analytics, automation, and contemporary business intelligence capabilities.

• Propel the modernization of analytics platforms, data solutions, and self-service reporting tools.

• Leverage predictive analytics and data visualization to enhance insight generation and forecasting.

• Collaborate with Informatics, Data Engineering, and IT teams to develop scalable analytics solutions.

• Define KPI standards, governance frameworks, and an enterprise analytics structure.

• Manage analytics delivery priorities, intake management, work prioritization, resource allocation, and coordination.

• Lead, mentor, and cultivate a team of analytics and business intelligence professionals consisting of approximately 4–5 direct reports and a total of 7–8 employees.

• Collaborate with executive leaders across Risk Adjustment, Finance, Actuarial, Clinical, Provider, and IT organizations.

• Promote accountability, innovation, collaboration, and ongoing learning.

⛳️ Requirements

• Over 10 years of experience in healthcare analytics, informatics, performance insights, actuarial science, value-based care, or business intelligence.

• More than 2 years of leadership experience overseeing analytics, reporting, or business intelligence functions.

• Strong skills in executive communication, strategic thinking, stakeholder management, and team development.

• Advanced proficiency and familiarity with programming languages such as SQL and Python.

• Experience with BI platforms including Power BI, Tableau, and QuickSight.

• Proven track record in managing complex analytics portfolios, setting priorities, and maintaining organization in developer code and processes.

• Bachelor’s degree or equivalent professional experience.

• Preferred knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements.

• Experience within a health plan or provider system is preferred.

• A Master’s degree or equivalent advanced education, professional certification, or demonstrated subject matter expertise is preferred.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Target award in the company’s equity award program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.