Senior Manager, Provider Data Operations – Attribution Integrity

Job not on LinkedIn

🔥 0 minutes ago

🌵 Arizona, Colorado, +23 more states – Remote

🌵 Arizona – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌪️ Kansas – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote

💵 $67.9k - $199.1k / year

⏰ Full Time

🟠 Senior

⚙️ 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

• Lead attribution, membership, and provider data governance processes • Oversee resolution of provider data and attribution issues affecting member assignment, reporting accuracy, and downstream operations • Partner with health plan leaders, network teams, provider data teams, claims, compliance, marketing, operations, and technology partners • Deliver projects supporting business performance, regulatory requirements, and customer experience • Support provider directory accuracy, audit readiness, and regulatory validation through monitoring, documentation, and issue remediation • Identify recurring defects, root causes, and control gaps • Drive process improvements that reduce rework and improve operational reliability • Maintain governance routines, process documentation, and cross-functional coordination

🎯 Requirements

• 7–10 years of experience • 5+ years of experience in Medicaid, managed care operations, provider data, or 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 • Ability to identify root causes and recommend corrective actions • Experience investigating and resolving provider data issues, including provider identifiers, affiliations, and contractual relationships • Experience coordinating cross-functional issue resolution and operational improvements • Strong communication skills and ability to translate complex operational issues into 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 • Experience investigating member attribution or provider assignment discrepancies • Experience managing, validating, or reconciling provider rosters • Experience managing provider data, directory accuracy, or related operational issues across multiple teams • Bachelor's degree or equivalent professional experience

🏖️ Benefits

• Medical, dental, and vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program • Equity award program