Sr. Manager, Provider Data Operations & Attribution Integrity

CVS Health; Elm (PA); Presencial; USD 120.000 - 180.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Other resources

Descripción de la vacante

CVS Health is seeking a Senior Manager to lead Medicaid data governance, attribution, and related operations. You will collaborate with provider relations, IT, analytics, claims, and compliance to ensure accurate provider data and reliable downstream reporting.

The role emphasizes end-to-end governance, issue resolution, root-cause analysis, and process improvements. A Bachelor's degree and 5+ years in Medicaid or managed care data, with SQL, Excel, Power BI, Tableau, and QNXT/MDW experience are

Formación

• 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 investigate, analyze, and reconcile complex health care data, identify root causes, and recommend corrective actions.
• Experience managing provider attribution methodologies, governance, reporting, and operational execution.

Responsabilidades

• 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.

Conocimientos

SQL

Advanced Excel

Power BI

Tableau

Data analysis

Communication

Educación

Bachelor's degree or equivalent professional experience

Herramientas

QNXT

MDW (Medicaid Data Warehouse)

Descripción del empleo

We’re building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

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.

• 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.

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.
• Strong communication skills, including the ability to translate complex operational issues into clear business risk, action plans, and ownership.

• 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 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.

Bachelor's degree or equivalent professional experience.

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. 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 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.

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.

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources

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.