Provider Data & Attribution Integrity Lead, Medicaid Ops

CVS Health; East Windsor Hill (CT); On-site; USD 110,000 - 160,000; Full time

Benefits offered by this job

Comprehensive benefits package

Paid time off

Retirement savings options

Wellness programs

Other resources

Job summary

CVS Health is seeking a Senior Manager to lead provider data governance within Medicaid operations. You will ensure data integrity, drive attribution governance, and coordinate with provider data, analytics, claims, IT, and compliance teams to deliver accurate downstream outputs.

The role emphasizes identifying root causes, implementing process improvements, and maintaining governance routines to support regulatory requirements and customer experience.

Qualifications

• 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.
• Ability to independently investigate, analyze, and reconcile complex health care data, identify root causes, and recommend corrective actions.
• Experience investigating and resolving provider data issues, including discrepancies involving provider identifiers, affiliations, contractual relationships, etc.
• Strong communication skills, including the ability to translate complex operational issues into clear business risk, action plans, and ownership.

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.
• Partner 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

Analytical thinking

Communication skills

Problem solving

Attention to detail

Project coordination

Education

Bachelor's degree or higher

Tools

SQL

Excel

Power BI

Tableau

QNXT

MDW

Job description

CVS Health is seeking a Senior Manager to lead provider data governance within Medicaid operations. You will ensure data integrity, drive attribution governance, and coordinate with provider data, analytics, claims, IT, and compliance teams to deliver accurate downstream outputs.

The role emphasizes identifying root causes, implementing process improvements, and maintaining governance routines to support regulatory requirements and customer experience.