Note: The job is a remote job and is open to candidates in USA. CVS Health is hiring a senior manager to lead provider data integrity, attribution governance, and operational controls supporting Medicaid operations. The role oversees data governance and issue resolution, supports directory accuracy and regulatory validation, and coordinates with cross-functional teams to improve operational reliability.
Responsibilities
- 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
Skills
- 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
- 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 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
Benefits
- CVS Health bonus, commission or short-term incentive program
- An award target in the company’s equity award program
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
Company Overview