Senior Manager, Medicaid Implementations – Provider Data

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. Role Summary The Senior Manager, Medicaid Implementations – Provider Data is accountable for leading provider data readiness, execution, and stabilization activities for Medicaid implementations, expansions, and complex provider network initiatives. This role serves as the senior Provider Data implementation lead, ensuring accurate, compliant, and timely provider data configuration to support successful Medicaid go‑lives and ongoing operational stability. The Senior Manager partners closely with Implementation Leadership, Provider Operations, Credentialing, IT, and Health Plan stakeholders to deliver high‑quality provider data outcomes across large, medium, and complex Medicaid implementations.

Requirements

• 7+ years of experience in Medicaid provider data, provider operations, or healthcare implementations.
• 3+ years of people leadership experience at the Manager or Senior Manager level.
• Deep understanding of Medicaid provider data requirements, including network builds, expansions, and state‑specific nuances.
• Demonstrated experience leading complex, cross‑functional initiatives in a fast‑paced environment.
• Strong analytical, problem‑solving, and executive communication skills.

Nice To Haves

• Experience supporting large or de novo Medicaid implementations.
• Familiarity with provider data systems (e.g., QNXT or similar platforms).
• Experience working with provider directories, claims impacts, and regulatory compliance requirements.
• Proven ability to influence without authority across enterprise teams.

Responsibilities

• Medicaid Implementation Leadership Serve as the Provider Data implementation lead for Medicaid new market entries, expansions, de novo networks, and complex program launches. Own end‑to‑end Provider Data readiness from implementation intake through post‑go‑live stabilization. Assess implementation scope and complexity to determine Provider Data staffing, timelines, and execution approach. Provide strategic guidance and risk mitigation planning for provider data impacts across implementations.
• Provider Data Execution & Readiness Oversee provider data build, validation, and reconciliation activities to ensure accuracy, completeness, and regulatory compliance. Ensure provider data is configured to support claims, encounters, directories, and state reporting requirements. Lead cross‑functional issue resolution related to provider data defects, pends, or readiness risks during implementation. Drive root‑cause analysis for recurring provider data issues and implement corrective actions.
• People & Team Leadership Lead and mentor Provider Data Managers and project resources assigned to Medicaid implementations. Establish clear performance expectations, workload prioritization, and accountability across implementation teams. Ensure consistent execution standards and best practices across all Provider Data implementation efforts.
• Stakeholder & Cross‑Functional Partnership Act as the primary Provider Data liaison to Medicaid Implementation leadership, IT, Credentialing, Network, and Health Plan partners. Communicate implementation status, risks, and mitigation plans to senior leadership. Influence decisions related to provider data timelines, scope, and readiness criteria.
• Process Improvement & Standardization Contribute to the development and evolution of standardized Provider Data implementation playbooks and workflows. Identify opportunities to reduce manual effort, improve data quality, and streamline implementation processes. Support enterprise initiatives related to provider data standardization and scalability.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed