Lead Director, Risk Adjustment Performance Reporting, Insights

This is a fully remote position, open to applicants in Idaho, +2 more states.

📋 Description

• Spearhead the development and implementation of enterprise risk adjustment analytics and business intelligence solutions.

• Convert clinical, operational, and risk adjustment data into actionable insights to enhance provider performance, program efficiency, and executive decision-making.

• Drive action through data storytelling and sophisticated visualizations.

• Elevate the organization’s reporting strategy by leveraging AI and automation.

• Provide customer-facing thought leadership and vision collaboration with Market, Finance, Clinical, and Operational partners.

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

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

• Quantify risk movement drivers and deliver insights to business leaders.

• Evaluate performance against objectives through benchmarking and goal setting.

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

• Utilize claims, encounter, and clinical healthcare data to identify outcome drivers.

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

• Track provider performance metrics and pinpoint 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.

• Drive the adoption of AI, advanced analytics, automation, and contemporary business intelligence capabilities.

• Modernize analytics platforms, data solutions, and self-service reporting tools.

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

• Partner with Informatics, Data Engineering, and IT teams to create scalable analytics solutions.

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

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

• Lead, mentor, and cultivate an analytics and business intelligence team consisting of approximately 4–5 direct reports and 7–8 total 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, value-based, or business intelligence.

• At least 2 years in a leadership role managing analytics, reporting, or business intelligence teams.

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

• Advanced proficiency in programming languages such as SQL and Python.

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

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

• In-depth knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory standards.

• Experience working within a health plan or provider system.

• Bachelor’s degree or equivalent professional experience is required.

• A Master’s degree in a relevant field, advanced education, professional certification, or demonstrated subject matter expertise is preferred.

🏝️ 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.

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