Senior Manager, Healthcare Medicaid Risk Adjustment Analytics
New
C
CVS HealthHealthcare Analytics
United StatesFull-TimeManager
Salary$67,900.00 - $199,144.00
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Job Details
- Experience
- 8+ years of relevant professional experience
- Required Skills
- PythonSQLGCPTableauData modeling
Requirements
- 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.
- Experience with risk adjustment methodologies and performance analytics (preferred).
- Knowledge of CMS and state Medicaid data, reporting, and compliance requirements (preferred).
- Experience with data visualization tools such as Tableau or Power BI (preferred).
- Bachelor's degree preferred or a combination of professional work experience and education.
Responsibilities
- 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.
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