Sr. Manager, Provider Data Operations & Attribution Integrity

CVS Health; Maine; On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Senior Manager to lead attribution governance and provider data operations within Medicaid. You will collaborate across provider data management, IT, analytics, claims, and other teams to ensure accurate data and reliable downstream processes.

You will leverage SQL, Excel, Power BI, and Tableau to analyze complex healthcare data, identify root causes, and drive corrective actions. Strong communication and cross-functional partnership are essential.

Qualifications

• 5+ years of experience in Medicaid, managed care operations, provider data, healthcare analytics.
• Experience with SQL, advanced Excel, Power BI, Tableau, or comparable tools.
• Experience with provider attribution and data governance.
• Strong communication skills to translate issues into business actions.

Responsibilities

• Lead attribution, membership, and provider data governance processes to ensure accurate and reliable outputs.
• Oversee resolution of provider data and attribution issues affecting member assignment and reporting accuracy.
• Partner with health plan leaders and cross-functional teams to deliver projects supporting performance, regulatory requirements, and customer experience.
• Support provider directory accuracy, audit readiness, and regulatory validation activities through monitoring and remediation.
• Identify defects, root causes, and control gaps; drive process improvements to reduce rework.
• Maintain governance routines and cross-functional coordination for attribution and provider data operations.

Skills

Data analysis

Communication

Problem solving

Education

Bachelor's degree or equivalent professional experience

Tools

SQL

Advanced Excel

Power BI

Tableau

Job description

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.

Key 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.
• 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 & 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 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

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Compensation

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.

Benefits

• 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.