Healthcare Medicaid Risk Adjustment Analytics, Senior Manager Remote

Job Title: Healthcare Medicaid Risk Adjustment Analytics, Senior Manager Remote

Job Location: Work at Home, Massachusetts, United States

Job Location Type: Remote

Job Contract Type: Full-time

Job Seniority Level:

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.

Position Summary

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.

• 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

Join this exciting opportunity to work directly with different teams across the organization and have a meaningful impact on our business!

Required Qualifications

• 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

Preferred Qualifications

• 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)

Education

• Bachelor's degree preferred or a combination of professional work experience and education.

Pay Range

The typical pay range for this role is:

$67,900.00 - $199,144.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/15/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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Originally posted on Himalayas