Sr. Manager, Provider Data and Network Operations
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. Oak Street Health®, a part of CVS Health, helps older adults stay healthier and live fuller lives through our 230 centers across 27 states. Our value-based care model helps us consistently deliver better patient experiences and outcomes. Oak Street's Preferred Network is a direct lever on outpatient Part B medical cost, the kind of cost that determines whether our value-based model works. A well-designed network that field teams don't trust, because the data behind it is wrong, doesn't move that cost. You make sure the data is right so the network can do the job it exists to do. This is a hands-on, high-ownership role at a company moving from legacy systems into Epic, at real speed. You'll inherit real, unresolved problems, not a finished system, and the chance to build the operational backbone of a program that manages a meaningful share of our medical spend.
Requirements
- 5+ years in healthcare data or network operations, provider data management, or a closely adjacent analytics function - value-based care, Medicare Advantage, or a health plan/health system network operations background strongly preferred
- Direct, hands-on experience with provider or facility directory data at scale - you have personally owned a process for validating, correcting, or maintaining provider/facility records, not just consumed a clean dataset someone else built
- Strong SQL and demonstrated ability to build and maintain data pipelines or workflows independently (tools like Snowflake, Alteryx, Dataiku, or equivalent)
- Experience managing external vendor relationships and cross-functional internal partnerships - this role sits at the intersection of several teams that do not report to it
- Comfort operating with incomplete or actively-changing source-of-truth systems, and judgment for when to escalate versus when to build a workaround
Nice To Haves
- Exposure to claims-based provider performance or quality scoring methodologies (episode-based cost and quality scoring, risk-adjusted comparisons)
- Experience with Epic, particularly Epic-based referral or provider-directory workflows
- People-management experience, particularly developing early-career analysts
- Experience in a value-based care or Medicare Advantage network-management context specifically
Responsibilities
- Own the eligibility methodology, in partnership with our claims-data vendor, that determines which specialists and facilities qualify for the Preferred Network
- Run the recurring refresh process that keeps the network current as vendor scoring data updates
- Own the insurance-plan crosswalk that tells our internal verification team which plans to verify, and drives insurance-record edits
- Own the analysis that verifies our Preferred Network actually reaches patients, geographically and by insurance network
- Rebuild the technical pipeline behind that analysis as our data infrastructure evolves post-Epic migration
- Own the processes that get specialist and facility data into Epic accurately and keep it current
- Partner with internal Provider Data Management, engineering, and informatics teams on data-source design and defect resolution
- Serve as the fix destination for provider and facility data issues surfaced through field-reported complaints
- Own vendor relationships for claims-based network scoring and provider-directory data - contract performance, data quality issues, and roadmap input
- Own the verification partnership with our internal provider-data verification team - what gets verified, how often, and how findings get corrected in our source systems
- Manage and develop one to two analysts into strong data and network-operations practitioners
Benefits
- Mission-focused career impacting change and measurably improving health outcomes for medicare patients
- Paid vacation, sick time, and investment/retirement 401K match options
- Health insurance, vision, and dental benefits
- Opportunities for leadership development and 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
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
