Senior Director Performance Risk Adjustment Jobs

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Revenue Integrity is seeking a Lead Director, Informatics (Performance Reporting & Insights) to lead the development and delivery of enterprise risk adjustment analytics and business intelligence solutions. This role transforms complex clinical, operational, and risk adjustment data into actionable insights that will drive provider performance, program efficiency, and executive decision-making. This leader will be responsible for creating action through data storytelling, advanced visualizations, and helping to advance the organization's reporting strategy through AI and automation.

This role is customer-facing and will provide thought leadership and vision partnership to areas such as Market leads, Finance, Clinical, and Operational partners. The leader must also provide technical guidance to staff on BI tool input modeling and calculations.

• Accountable for timely and accurate sharing of risk adjustment KPIs, trends, and performance drivers at a market, plan, and provider level through dashboards and reporting tools
• Quantify drivers of risk movement and surface those insights to business leaders for action
• Assess performance against operational and organizational objectives, including appropriate benchmarking and goal setting
• Deliver executive insights and recommendations that support market strategy, operational planning, and performance improvement initiatives.
• Leverage underlying healthcare data, including claims, encounter, and clinical information, for deeper level learnings on drivers of outcomes

• Develop and oversee provider performance analytics that deliver actionable insights into gap closure, engagement, and overall risk adjustment outcomes.
• Monitor provider performance across key metrics and identify variation, emerging trends, opportunities, and best practices across markets, specialties, and lines of business.
• Partner with provider, clinical, and operational leaders to support performance improvement initiatives through data-driven insights and targeted intervention strategies.
• Evaluate the effectiveness of provider-facing risk adjustment programs, value-based care, point-of-care enablement solutions, and other clinical and operational initiatives.

• Lead in the adoption of AI, advanced analytics, automation, and modern business intelligence capabilities.
• Drive modernization of analytics platforms, data solutions, and self-service reporting tools.
• Leverage predictive analytics and data visualization to improve insight generation and forecasting
• Partner with Informatics, Data Engineering, and IT teams to build scalable, integrated analytics solutions.
• Establish KPI definitions, governance standards, and a trusted enterprise analytics framework.
• Establish and oversee analytics delivery priorities, ensuring effective intake management, work prioritization, resource allocation, and coordination across reporting and stakeholder needs

• Lead, mentor, and develop a high-performing analytics and business intelligence team (approx. 4-5 direct reports and overall scope 7-8 employees)
• Partner with executive leaders across Risk Adjustment, Finance, Actuarial, Clinical, Provider, and IT organizations.
• Foster a culture of accountability, innovation, collaboration, and continuous learning
• Champion and encourage new ideas, thinking, and ways to incorporate AI and advanced technology into everyday work.

• 10+ years of healthcare analytics, informatics, performance insights, actuarial, value-based, or business intelligence experience.
• 2+ years of leadership experience managing analytics, reporting, or business intelligence
• Strong executive communication, strategic thinking, stakeholder management, and team development skills.
• Advanced experience and familiarity with programming languages (such as SQL, Python, etc.) and BI platforms such as Power BI, Tableau, QuickSight
• Proven ability to lead complex analytics portfolios, establish priorities, and maintain organization in developer code and processes

• Demonstrated knowledge of Medicare, Medicaid, or ACA risk adjustment methodologies, HCC models, healthcare claims and clinical data, and CMS regulatory requirements.
• Experience at a health plan or provider system

• Bachelor's degree or equivalent professional work experience
• Master's degree in Business, Informatics, Analytics, Finance, Statistics, Computer Science, Public Health, Healthcare analytics, Actuarial, Mathematics, Economics, or equivalent combination of advanced education, professional certification, or demonstrated subject matter expertise preferred

The typical pay range for this role is: $100,000.00 - $231,540.00

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.

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: 09/06/2026

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