Sr. Manager, Provider Data Operations & Attribution Integrity

CVS Health•Washington, DC

2d•$67,900 - $199,144

About The Position

Leads provider data integrity, attribution governance, and related operational controls supporting Medicaid operations. The senior manager serves as a key liaison among provider relations, provider data management, information technology, analytics, claims, and other operational departments to ensure provider and attribution information is accurate, consistently maintained, and appropriately reflected in downstream systems and business processes.

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, identify root causes, and recommend corrective actions.
Experience investigating and resolving provider data issues, including discrepancies involving provider identifiers, affiliations, and contractual relationships.
Experience coordinating cross-functional issue resolution and operational improvements.
Strong communication skills, including the ability to translate complex operational issues into clear business risk, action plans, and ownership.
Bachelor's degree or equivalent professional experience.

Nice To Haves

Experience managing provider attribution methodologies, governance, reporting, and operational execution.
Experience leveraging QNXT and Medicaid Data Warehouse (MDW) data to support operational decision-making, reporting, and issue resolution.
Experience investigating member attribution or provider assignment discrepancies.
Experience managing, validating, or reconciling provider rosters, including identifying and resolving inconsistencies across systems.
Experience managing provider data, directory accuracy, or related operational issues across multiple teams.

Responsibilities

Lead attribution, membership, and provider data governance processes to ensure accurate and reliable operational outputs.
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 on 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, then drive process improvements that reduce rework and improve operational reliability.
Maintain governance routines, process documentation, and cross-functional coordination for attribution and provider data operations.