CVS Health
CVS Health
CVS Health is an American healthcare company working across healthcare services, health insurance, pharmacy benefits management, and retail pharmacy. Through businesses including Aetna and CVS Caremark, it supports health coverage, prescription access, condition management, specialty medications, and mail-order pharmacy services. Its neighborhood pharmacies and broader care offerings are designed to help people access essential healthcare more conveniently and affordably. CVS Health brings together insurance, pharmacy, and health services to support individuals and communities throughout their care journeys.

Senior Data Scientist, Clinical Informatics and Analytics Enablement at CVS Health (Remote)

Senior Data Scientist focused on clinical informatics and analytics enablement at CVS Health. Develops reusable healthcare data assets, quality frameworks, and clinical data solutions for analytics, modeling, and AI.

Description

  • Act as a clinical data subject matter expert across CCD records, claims, pharmacy data, lab results, and clinical documentation
  • Design and manage clinical data models, taxonomies, and classification frameworks
  • Build and govern the clinical data feature store with defined standards, documentation, and best practices
  • Create validated, well-documented, reusable tables, views, features, and other data assets
  • Maintain data dictionaries, lineage records, business logic, limitations, and appropriate-use guidance
  • Develop queries, dashboards, and visualizations that convey data quality, availability, and clinical findings
  • Work with clinical, operational, and business partners to turn data requirements into practical solutions
  • Manage data quality frameworks, validation rules, anomaly detection, and monitoring workflows
  • Convert clinical concepts into structured analytical frameworks
  • Partner with data engineering teams to develop clinical data pipelines
  • Support HIPAA compliance, data privacy, and data stewardship efforts
  • Provide training, presentations, and consultations for people who use the data
  • Keep current with HL7, FHIR, ICD-10, SNOMED-CT, LOINC, CPT, NDC, and RxNorm standards

Requirements

  • At least four years of relevant experience in clinical informatics, healthcare analytics, or clinical data management
  • Deep familiarity with clinical data types and structures, including CCD records, laboratory results, clinical notes, and administrative healthcare data
  • Strong command of clinical coding systems and terminologies such as ICD-10, CPT, HCPCS, SNOMED-CT, LOINC, NDC, and RxNorm
  • Experience creating and documenting healthcare data models, taxonomies, or classification frameworks
  • Ability to assist analysts, data scientists, and business users through documentation, training, and consulting
  • Proficiency in SQL and large healthcare datasets
  • Experience using cloud data platforms; Google Cloud tools such as BigQuery are preferred
  • Solid understanding of healthcare data quality, including validation, profiling, and monitoring
  • Excellent written and spoken communication skills
  • Bachelor’s degree in health informatics, Public Health, Nursing, Health Information Management, Computer Science, Statistics, or a related quantitative or clinical discipline, or an equivalent combination of education and experience
  • Preferred experience combining clinical and administrative data into unified, patient-centered models
  • Preferred experience normalizing and standardizing patient data
  • Preferred experience reconciling clinical and claims data
  • Preferred experience incorporating third-party and enrichment data sources
  • Preferred expert knowledge of additional clinical and administrative coding systems, including ICD-10-CM/PCS, CPT/HCPCS, SNOMED-CT, RxNorm, NDC, LOINC, and NPI
  • Preferred experience with HCC, CCS, DRG, and therapeutic class hierarchies
  • Preferred experience designing patient-centered data models, feature stores, and dashboards
  • Preferred experience producing data dictionaries, lineage documentation, and self-service analytics layers
  • Preferred understanding of care management, value-based care, HEDIS, Stars, and population health

Benefits

  • Medical insurance coverage
  • Dental insurance coverage
  • Vision insurance coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs
  • Resources supporting physical, emotional, and financial well-being
  • CVS Health bonus, commission, or short-term incentive opportunity in addition to base pay

Related Jobs

Arkansas Blue Cross and Blue Shield

Remote Medical Claims Specialist

Arkansas Blue Cross and Blue Shield

Process medical claims that require manual review for Arkansas Blue Cross and Blue Shield, investigating benefits, eligibility, coding, audits, and processing issues. This full-time remote role is based in the United States.

Open
Great American Insurance Group

Senior Workers' Compensation Claims Specialist - Great American Insurance Group (Remote)

Great American Insurance Group
5,001 – 10,000 Employees
B2BInsurance

Handle complex workers’ compensation claims in California and Oregon for Strategic Comp, a specialty insurance provider. Investigate claims, set reserves, negotiate settlements, and guide cases to resolution in a remote role.

Open