Senior Manager, Provider Data and Network Operations

Job not on LinkedIn

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $82.9k - $182.5k / year

⏰ Full Time

🟠 Senior

🌐 Network Operations

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Own the eligibility methodology determining which specialists and facilities qualify for the Preferred Network • Run the recurring network refresh process as vendor scoring data updates • Own the insurance-plan crosswalk for internal verification and insurance-record edits • Analyze whether the Preferred Network reaches patients geographically and by insurance network • Rebuild the technical pipeline behind network adequacy analysis after Epic migration • Own processes for accurately entering and maintaining specialist and facility data in Epic • Partner with Provider Data Management, engineering, and informatics teams on data-source design and defect resolution • Resolve provider and facility data issues surfaced through field-reported complaints • Own vendor relationships for claims-based network scoring and provider-directory data • Manage contract performance, data quality issues, and vendor roadmap input • Own the internal provider-data verification partnership, including verification scope, frequency, and corrections • Manage and develop one to two analysts into strong data and network-operations practitioners • Partner with the Sr. Manager responsible for referral optimization and network utilization

🎯 Requirements

• 5+ years in healthcare data or network operations, provider data management, or a closely adjacent analytics function • Value-based care, Medicare Advantage, or health plan/health system network operations background strongly preferred • Direct, hands-on experience with provider or facility directory data at scale • Personally owned processes for validating, correcting, or maintaining provider/facility records • Strong SQL • Demonstrated ability to build and maintain data pipelines or workflows independently • Experience with tools such as Snowflake, Alteryx, Dataiku, or equivalent • Experience managing external vendor relationships and cross-functional internal partnerships • Comfort operating with incomplete or actively-changing source-of-truth systems • Judgment for when to escalate versus when to build a workaround • Exposure to claims-based provider performance or quality scoring methodologies preferred • Experience with Epic, particularly Epic-based referral or provider-directory workflows, preferred • People-management experience, particularly developing early-career analysts, preferred • Experience in a value-based care or Medicare Advantage network-management context specifically, preferred

🏖️ Benefits

• Mission-focused career impacting change and measurably improving health outcomes for medicare patients • Paid vacation and sick time • Investment/retirement 401K match options • Health insurance, vision, and dental benefits • Opportunities for leadership development • Continuing education stipends • New centers and flexible work environments • Opportunities for high levels of responsibility and rapid advancement • Medical, dental, and vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources based on eligibility • CVS Health bonus, commission or short-term incentive program • Award target in the company’s equity award program