Sr. Manager, Provider Data Operations & Attribution Integrity

CVS Health; United States; Remote; USD 68,000 - 199,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Eligibility-based resources

Job summary

CVS Health in the United States is seeking a Senior Manager to lead provider data governance, attribution governance, and related controls supporting Medicaid operations. You will serve as a key liaison across provider relations, data management, IT, analytics, claims, and other teams to ensure accuracy and downstream consistency.

This role requires 7–10 years of Medicaid/managed care experience, strong SQL/Excel/BI skills, and a proven track record of cross-functional collaboration to drive

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.

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

SQL

Advanced Excel

Power BI

Tableau

Education

Bachelor's degree

Tools

QNXT

Medicaid Data Warehouse (MDW)

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.

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 and 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’re 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.

• medical coverage
• dental coverage
• vision coverage
• paid time off
• retirement savings options
• wellness programs
• 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.

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people.

Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.