Manager Medicaid Provider Data Services

CVS Health

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About The Position

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. Position Summary Lead a team of Medicaid Provider Data Services Analysts responsible for loading and maintaining Medicaid Provider data within Aetna QNXT. Team will also include provider operations analyst and potential pre-cred support for implementation activities. Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Coordinates provider status information with member services and other internal departments. Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions. Monitors staff performance, including weekly staff metrics; coaches and mentors’ staff on performance issues or concerns.

Requirements

• 3+ years of recent and related experience in Provider Operations, Provider Relations, or Network operations.
• 1+ years of experience in Medicaid provider operations.
• At least 1 year of experience with ensuring the provider data entered into the provider database is accurate and the provider documentation is complete and accurate.
• 1+ years of experience in managing, coaching, and leading a team of Provider Data Services Analysts.
• At least 1 years of experience leading or managing a production-oriented team.

Nice To Haves

• Strong collaboration skills.
• Strong reporting and data analysis skills and experience.
• Ability to load balance and prioritize work to meet key performance metrics around TAT and quality.
• Drive and oversee productivity of staff.
• Experience with new Medicaid state implementation related to provider requirements.
• Leadership skills including staff development.
• Critical thinking and problem-solving skills.
• Familiarity with Provider Data/Enterprise systems.
• Strong skills in Microsoft products.
• QuickBase knowledge.

Responsibilities

• Lead a team of Medicaid Provider Data Services Analysts responsible for loading and maintaining Medicaid Provider data within Aetna QNXT.
• Team will also include provider operations analyst and potential pre-cred support for implementation activities.
• Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc.
• Coordinates provider status information with member services and other internal departments.
• Recruits, develops, and motivates staff.
• Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions.
• Monitors staff performance, including weekly staff metrics; coaches and mentors’ staff on performance issues or concerns.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager