Lead Director, Provider Data Services

CVS Health•Hartford, CT

1d•Onsite

About The Position

The Lead Director, Provider Data Services provides enterprise leadership across multiple Provider Data Services units and is accountable for the end‑to‑end delivery of provider data operations, including production, quality assurance, audit, reporting, and continuous process improvement. This role oversees the maintenance of provider data across Behavioral Health, National, Dental, Indirect, and First Health networks, ensuring accurate, timely, and compliant provider records that support proper reimbursement and member access, including directory accuracy. The Lead Director aligns Provider Data Services policies, procedures, and operating standards with enterprise goals and regulatory requirements, while delivering financial, operational, and service outcomes. This role provides leadership through multiple layers of management and vendor partners, setting strategic direction, establishing priorities, and driving operational excellence at scale.

Requirements

10+ years of experience in managed care, network operations, provider data, or health insurance, including large‑scale production environments.
Demonstrated experience leading complex operations through multiple layers of management.
Proven ability to drive execution, operational rigor, and measurable outcomes in a matrixed organization.
Advanced working knowledge of systems, applications, and tools supporting provider data and inventory management.
Strong record of cross‑functional collaboration and influencing at senior leadership levels.
Ability to lead change, apply analytical thinking, and make data‑driven decisions.
Demonstrated sound judgment in complex, regulated operational environments.

Nice To Haves

Experience managing offshore or external vendor partnerships.
Project or program management experience within large, regulated organizations.

Responsibilities

Accountable for the operational performance of Commercial and Medicare provider data services functions.
Lead and direct a highly complex operation of 100+ colleagues through multiple managers.
Provide oversight of offshore vendor partnerships, ensuring capacity planning, inventory management, and service level alignment with business objectives.
Define and execute provider data process improvement strategies to address performance trends, risk, and scalability.
Drive change management initiatives that enable modernization, efficiency, and adaptability within a dynamic healthcare environment.
Ensure consistent execution of Provider Data Services policies and procedures across the enterprise.
Oversee audit programs and quality controls to maintain accurate provider records supporting reimbursement integrity, contractual compliance, and directory accuracy.
Partner with internal stakeholders to mitigate risk, address audit findings, and maintain regulatory readiness.
Build, develop, and sustain a strong leadership bench through formal training, coaching, mentoring, performance management, and succession planning.
Cultivate and manage strategic relationships with internal business partners across Network, Credentialing, Operations, Compliance, and Technology.
Influence and align cross‑functional teams to advance Provider Data Services priorities and enterprise initiatives.
Control departmental resources to achieve financial targets and operational objectives within established budget parameters.
Contribute to enterprise planning and execution of initiatives that advance Provider Data Services strategy and value delivery.