Note: The job is a remote job and is open to candidates in USA. CVS Health, through Oak Street Health, provides value-based primary care for older adults and is seeking a Senior Manager to lead Preferred Network operations and provider data governance. The role owns network eligibility, refresh processes, coverage analysis, provider and facility data integrity, vendor and verification partnerships, operational improvements, and analyst development during the transition to Epic.
Responsibilities
- Own the eligibility methodology, in partnership with our claims-data vendor, that determines which specialists and facilities qualify for the Preferred Network
- Run the recurring refresh process that keeps the network current as vendor scoring data updates
- Own the insurance-plan crosswalk that tells our internal verification team which plans to verify, and drives insurance-record edits
- Own the analysis that verifies our Preferred Network actually reaches patients, geographically and by insurance network
- Rebuild the technical pipeline behind that analysis as our data infrastructure evolves post-Epic migration
- Own the processes that get specialist and facility data into Epic accurately and keep it current
- Partner with internal Provider Data Management, engineering, and informatics teams on data-source design and defect resolution
- Serve as the fix destination for provider and facility data issues surfaced through field-reported complaints
- Own vendor relationships for claims-based network scoring and provider-directory data - contract performance, data quality issues, and roadmap input
- Own the verification partnership with our internal provider-data verification team - what gets verified, how often, and how findings get corrected in our source systems
- Manage and develop one to two analysts into strong data and network-operations practitioners
Skills
- 5+ years in healthcare data or network operations, provider data management, or a closely adjacent analytics function - value-based care, Medicare Advantage, or a health plan/health system network operations background strongly preferred
- Direct, hands-on experience with provider or facility directory data at scale - you have personally owned a process for validating, correcting, or maintaining provider/facility records, not just consumed a clean dataset someone else built
- Strong SQL and demonstrated ability to build and maintain data pipelines or workflows independently (tools like Snowflake, Alteryx, Dataiku, or equivalent)
- Experience managing external vendor relationships and cross-functional internal partnerships - this role sits at the intersection of several teams that do not report to it
- Comfort operating with incomplete or actively-changing source-of-truth systems, and judgment for when to escalate versus when to build a workaround
- Exposure to claims-based provider performance or quality scoring methodologies (episode-based cost and quality scoring, risk-adjusted comparisons)
- Experience with Epic, particularly Epic-based referral or provider-directory workflows
- People-management experience, particularly developing early-career analysts
- Experience in a value-based care or Medicare Advantage network-management context specifically
Benefits
- Mission-focused career impacting change and measurably improving health outcomes for medicare patients
- Paid vacation, sick time, and investment/retirement 401K match options
- Health insurance, vision, and dental benefits
- Opportunities for leadership development and continuing education stipends
- New centers and flexible work environments
- Opportunities for high levels of responsibility and rapid advancement
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
Company Overview
Company H1B Sponsorship