Lead Director, Medicare Advantage and Group ACA Risk Adjustment Informatics

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Summary     Revenue Integrity Informatics   is seeking a   Lead Director, Informatics   to lead Medicare Advantage and ACA risk adjustment analytics, predictive modeling, intervention strategy, and financial valuations. This role   is responsible for   driving risk score accuracy and completeness, ensuring regulatory compliance, and delivering actionable data-informed opportunities. The role is highly visible within the enterprise and will be a key contributor to strategic decision-making with senior management.      The Lead Director will manage a high-performing team (approximately 5 directs and overall scope 13) with backgrounds in data, analytics, and informatics to build opportunity algorithms, optimize processes, mitigate risks, and create business impact.      This role will work in close partnership with executive leadership, market leaders, finance, service operations, compliance, and vendor partners.      **This role may sit anywhere in the US.

Risk Adjustment & Business Performance   Lead enterprise risk adjustment analytics supporting risk score completeness, accuracy, engagement, recapture, and algorithms.   Leverage claims and clinical data for deep learning into drivers of performance and model impacts.   Proactively engage with stakeholders on emerging trends, rising risk, and data-driven opportunities   Oversee   the analytics that drive risk adjustment intervention activities, including prospective and retrospective programs.   Directs the prioritization and performance evaluation of outreach, engagement, and clinical documentation initiatives.     Predictive Analytics, AI & Innovation   Lead the development and implementation of advanced predictive analytics and AI solutions to support risk adjustment, population health, and business performance initiatives.   Drive innovation through automation, advanced analytics, and emerging technologies that improve efficiency and scalability   Measure and evaluate intervention effectiveness and overall business impact   Translate complex analytical findings into practical recommendations that improve operational, clinical, and financial outcomes.   Partner with technology and data engineering teams to enhance data architecture, automation, and analytics capabilities.     Strategic Leadership & Partnerships   Partner with executive leadership, market leaders, finance, actuarial, service operations, and clinical teams to support strategic planning and performance improvement efforts.   Provide executive-level presentations and recommendations that influence organizational strategy and investment decisions.   Manage data relationships with external vendors and business partners     Compliance & Regulatory Support   Ensure adherence to CMS regulations, data governance policies, and organizational compliance expectations.   Lead analytical support for compliance reviews and risk adjustment governance activities   Establish and   maintain   controls that promote data integrity, auditability, transparency, and accuracy.   Monitor regulatory and industry changes, assess business impact, and ensure   timely   implementation of   required   analytic and reporting enhancements.     People Leadership   Lead, mentor, and develop a high-performing team of leaders and individual contributors across analytics, informatics, data science, and related disciplines.   Foster a culture of collaboration, innovation, continuous improvement, and results-oriented