Lead Decision Scientist- Medicare Risk Adjustment

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A Brief Overview

Serves as the analytic lead and expert in supporting the Accurate Clinical Documentation team within the CVS Accountable Care Organization.  Will have at least three main functions:  1) learn, report, and produce productivity analytics from multiple systems, and 2) tracks risk adjustment performance at multiple analytic levels, and 3) becomes an expert on CMS risk adjustment policies, methods, and modeling.  Knowledge of HCC Medicare Risk Adjustment, impact, modeling, and reporting is required.  Additionally, will be responsible for all staff productivity reporting, designing reports, working with the Sr. Manager of Accurate Clinical Documentation to support operations.  This position will also interface with multiple analytic teams, working across teams to identify data needs, solutions, data gathering and summarizing for report outs to leadership.  Provides leadership and coordination of multiple analytics initiatives. Works closely with analytic partners and business stakeholders to develop solutions and deliver value.

**Position is posted as Remote in any location

What you will do:

• Able to work independently across internal teams and external vendors.

• Analyze data, produce outcomes analyses, make recommendations, and has a strong operational background to act independently to complete projects.

• Ability to work across analytic teams to gather data, analyze, produce reports, and PowerPoint presentations.

• Thorough understanding of HCC Medicare risk adjustment

• Responsible for identifying trends and opportunities for improvement.

• Work with lead directors across the CVS ACO organization to identify reporting needs for Accurate Clinical Documentation

• Understands to a high degree the reporting systems available, learns each system, generates reports, custom reports utilizing canned and extracts to create summaries for leadership.

• Ability to translate business problems into analytical solutions, structure data analysis, driving analytics insights and analytical solutions to help data scientists determine the best analytical solutions.

• Understanding key drivers of business value and being able to translate into business opportunities and frame them as analytical problems e.g., how to grow business.

• Ability to translate business problems into analytical solutions by knowing appropriate models to suggest to data scientists.

• Develops strategy with cross-functional teams to define key business problems and formulate data-driven hypotheses for exploration.

• Develops advanced statistical models to derive actionable insights and make data-driven decisions.

• Communicates findings and recommendations to stakeholders in a clear and concise manner, using data visualization and storytelling techniques to facilitate understanding and drive action.

• Provides mentorship and guidance to junior members of the team, fostering their professional growth and supporting their development in decision science techniques and methodologies.

• Manages team performance through regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.

• Stays updated with the latest advancements in decision science methodologies, machine learning, and statistical techniques, continually expanding knowledge and skills to enhance decision-making capabilities.

For this role you will need Minimum Requirements

• Minimum 5+ years’ work experience in analytics, data modeling, target setting, performance management

• Deep knowledge of advanced analytics tools and languages to analyze large data sets from multiple data sources.

• Adept at problem solving and decision-making skills.

• Adept at collaboration and teamwork

• Adept at growth mindset (agility and developing yourself and others) skills.

• Adept at execution and delivery (planning, delivering, and supporting) skills.

• Adept at business intelligence

• Demonstrates strong ability to communicate and present technical concepts and implications to senior leadership.

Preferred Qualifications

• Master’s degree or PhD

• HCC Medicare Risk Adjustment

Education

• Bachelor's degree or equivalent work experience in Mathematics, Statistics, Business Analytics, Economics, Physics, Computer Science, Engineering, Machine Learning, or related discipline

Pay Range

The typical pay range for this role is:

$106,605.00 - $260,590.00

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. 
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 10/21/2024

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