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.
Summary
Leads provider data integrity, attribution governance, and related operational controls supporting Medicaid operations. Ensures provider data, member attribution, and panel assignment outputs are accurate, explainable, and audit-ready to support reporting, provider accountability, financial settlement, and regulatory compliance.
Essential Functions
- Lead attribution, membership, and provider data governance processes to ensure accurate and reliable operational outputs.
- Oversee resolution of provider data and attribution issues that affect member assignment, reporting accuracy, and downstream operations.
- Partners with health plan leaders, network teams, provider data teams, claims, compliance, marketing, operations, and technology partners to deliver projects that support business performance, regulatory requirements, and customer experience.
- Support provider directory accuracy, audit readiness, and regulatory validation activities through monitoring, documentation, and issue remediation
- Identify recurring defects, root causes, and control gaps, then drive process improvements that reduce rework and improve operational reliability.
- Maintain governance routines, process documentation, and cross-functional coordination for attribution and provider data operations.
Required Qualifications
- Data governance, data quality, data management, reporting, or analytics
- 5+ years of experience in Medicaid, managed care operations, provider data, healthcare analytics.
- SQL, advanced Excel, Power BI, Tableau, or similar tools
- Healthcare analytics, provider data, Medicaid, managed care, or healthcare operations
- Investigating data quality and reporting issues, identifying root causes, and communicating findings to stakeholders
- Experience managing provider data, directory accuracy, or related operational issues across multiple teams.
- Strong communication skills, including the ability to translate complex operational issues into clear business risk, action plans, and ownership.
Preferred Qualifications
- Experience managing provider attribution methodologies, governance, reporting, and operational execution.
- Experience leveraging QNXT and Medicaid Data Warehouse (MDW) data to support operational decision-making, reporting, and issue resolution.
Education Bachelor's degree or equivalent professional experience
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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- Experience in data governance, data quality, data management, reporting, or analytics
- 5+ years of experience in Medicaid, managed care operations, provider data, or healthcare analytics
- Proficiency with SQL, advanced Excel, Power BI, Tableau, or similar tools
- Experience investigating data quality and reporting issues, identifying root causes, and communicating findings
- Experience managing provider data, directory accuracy, or related operational issues across multiple teams
- Strong communication skills, able to translate complex operational issues into business risk and action plans
- Experience with healthcare analytics, provider data, Medicaid, managed care, or healthcare operations
- Bachelor's degree or equivalent professional experience
- Experience managing provider attribution methodologies, governance, reporting, and operational execution
- Experience leveraging QNXT and Medicaid Data Warehouse (MDW) data to support decision-making and issue resolution
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
.png)
