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Summary
Leads provider data integrity, attribution governance, and related operational controls supporting Medicaid operations. The senior manager serves as a key liaison between provider relations, provider data management, information technology, analytics, claims, and other operational departments to ensure that provider and attribution information are accurate, consistently maintained, and appropriately reflected and downstream systems and business processes.
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
- 7-10 years of experience.
- 5+ years of experience in Medicaid, managed care operations, provider data, healthcare analytics.
- Experience with SQL, advanced Excel, Power BI, Tableau, or comparable analytical tools.
- Demonstrated ability to independently investigate, analyze, and reconcile complex health care data, identify root causes, and recommend corrective actions.
- Demonstrated experience investigating and resolving provider data issues, including discrepancies involving provider identifiers, affiliations, contractual relationships, etc.
- Experience coordinating cross-functional issue resolution and operational improvements.
- 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.
- Experience investigating member attribution or provider assignment discrepancies.
- Experience managing, validating, or reconciling provider rosters, including identifying and resolving inconsistencies across systems.
- Experience managing provider data, directory accuracy, or related operational issues across multiple teams.
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
- 7-10 years of professional experience
- 5+ years of experience in Medicaid, managed care operations, provider data, or healthcare analytics
- Experience with SQL, advanced Excel, Power BI, Tableau, or comparable analytical tools
- Ability to independently investigate, analyze, and reconcile complex healthcare data
- Experience identifying root causes and recommending corrective actions
- Experience investigating and resolving provider data issues involving provider identifiers, affiliations, and contractual relationships
- Experience coordinating cross-functional issue resolution and operational improvements
- Strong communication skills for translating complex operational issues into business risks, action plans, and ownership
- Bachelor's degree or equivalent professional experience
- Experience managing provider attribution methodologies, governance, reporting, and operational execution
- Experience using QNXT and Medicaid Data Warehouse data for operational decision-making, reporting, and issue resolution
- Experience investigating member attribution or provider assignment discrepancies
- Experience managing, validating, or reconciling provider rosters across systems
- Experience managing provider data, directory accuracy, or related operational issues across multiple teams
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Health coverage includes medical, dental, and vision with HSA-eligible options, free preventive care, virtual care, and access to MinuteClinic services. Mental-health resources such as counseling support are emphasized, and coverage is often considered solid for full-time colleagues.
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Retirement Support — A dollar-for-dollar 401(k) match up to 5% after one year and an Employee Stock Purchase Plan are consistently highlighted in Total Rewards materials. Feedback suggests retirement programs are a meaningful strength within the overall package.
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Wellbeing & Lifestyle Benefits — Wellbeing offerings include up to 20 no-cost counseling sessions per issue, backup care, tuition assistance, and substantial in-store discounts, alongside broader wellness tools. These everyday perks expand value beyond base pay and can be especially meaningful for full-time schedules.
CVS Health Insights
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.
