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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.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 11/07/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.