CVS Health

Sr. Manager, Provider Data and Network Operations

CVS Health$82K — $182K *
US-AnywhereRemote in Illinois, US
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • 5+ years in healthcare data or network operations, preferably in value-based care or Medicare Advantage
  • Hands-on experience validating, correcting, or maintaining large provider or facility databases
  • Strong SQL skills, capable of building and maintaining data pipelines independently
  • Experience managing relationships with vendors and internal cross-functional teams
  • Ability to navigate incomplete or changing data systems and make sound judgments on escalations

Responsibilities

  • Own eligibility methodology for Preferred Network specialists and facilities
  • Maintain network accuracy through a regular refresh process
  • Analyze geographic and insurance coverage of the Preferred Network
  • Ensure accurate specialist and facility data entry into Epic
  • Manage vendor partnerships for network scoring and data quality
  • Lead and mentor analysts in data and network operations

Benefits

  • Mission-driven role to improve health outcomes for Medicare patients
  • Paid vacation and sick time, plus retirement savings options
  • Comprehensive health insurance including vision and dental coverage
  • Opportunities for leadership development and continuing education
  • Flexible work environments and high responsibility roles
  • Rapid advancement potential within a growing organization
Full Job Description
Role Description:

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.

Core Responsibilities:

The Preferred Network can only deliver value when the underlying provider data is accurate, complete, and maintained. Currently, key data integrity challenges exist across the network, including incorrect preferred-provider designations, duplicate and misclassified specialist records in the EMR, and gaps in network coverage validation that emerged during the Epic transition.

As a Sr. Manager, you will play a critical role in supporting our Oak Street Health patients, providers and business by addressing these challenges through end-to-end ownership of Preferred Network operations and data governance. The role will define and maintain network eligibility criteria, oversee provider data accuracy, and ensure network information remains reliable within the tools and workflows used by care teams.

While the role contributes to network strategy, its primary focus is execution. The successful candidate will directly lead complex data-quality initiatives and operational improvements while partnering closely with the Sr. Manager will be responsible for referral optimization and network utilization. Together, they will ensure referrals are directed to an accurate, well-maintained, and high-performing Preferred Network.

Preferred Network Definition & Refresh (Primary)
  • 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

Coverage & Network Adequacy (Primary)
  • 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

Provider & Facility Data Integrity (Primary)
  • 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

Vendor & Verification Partnerships (Primary)
  • 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

Team Leadership (Primary)
  • Manage and develop one to two analysts into strong data and network-operations practitioners


What are we looking for?

Required
  • 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

Preferred
  • 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

What does being "Oaky" look like?
  • Radiating positive energy
  • Assuming good intentions
  • Driving clinical excellence
  • Taking ownership and delivering results
  • Being relentlessly determined


Oak Street Health 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


Pay Range

The typical pay range for this role is:

$82,940.00 - $182,549.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

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.

We anticipate the application window for this opening will close on: 11/30/2026

About CVS Health

Omnicare provides comprehensive pharmaceutical services to patients and providers across the United States. As the market-leader in professional pharmacy, related consulting and data management services for skilled nursing, assisted living and other chronic care settings, Omnicare leverages its unparalleled clinical insight into the geriatric market along with some of the industry's most innovative technological capabilities to the benefit of its long-term care customers. Omnicare also provides key commercialization services for the bio-pharmaceutical industry through its Specialty Care Group.

CVS Health Careers

Joining CVS Health presents a unique opportunity to advance your career in a company where innovation, leadership, and growth go hand in hand. As a leader in the healthcare industry, CVS Health is more than just a pharmacy. We are a team of professionals dedicated to improving lives and optimizing health outcomes.

Work You’ll Do

At CVS Health, you will be part of a culture that values diversity and inclusivity, fostering an environment where every team member’s contribution is valued. Engage in meaningful work that directly impacts lives, driving innovation in healthcare services and solutions.

Explore Job Opportunities

Whether you’re looking for a position in pharmacy services, corporate leadership, or in-store management, CVS Health offers a variety of employment opportunities that will help you harness your skills and thrive professionally. Our job opportunities span across a wide range of professional fields and geographic locations, ensuring that your career at CVS Health aligns with your professional goals and lifestyle.

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Kickstart your career with CVS Health through our internship programs. These opportunities are designed for ambitious students eager to develop their skills in a real-world setting. Internships at CVS Health are not only about gaining work experience but also about making meaningful contributions to our ongoing projects.

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CVS Health is committed to the professional growth of our employees. With access to cutting-edge technology, industry-leading experts, and comprehensive diversity training, our team members are equipped to lead and innovate. We support career advancement through professional development programs, leadership training, and opportunities for networking and internal mobility.

Benefits and Culture

Our employees enjoy a range of benefits that reflect our commitment to their well-being and success. From health and wellness benefits to professional development programs, CVS Health is dedicated to ensuring our team members have the resources they need. Our inclusive culture encourages collaboration and continuous learning, making CVS Health a place where you can grow and succeed.

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Learn more about CVS Health
Size
300,000 employees
Market Cap
$122 billion
Industry
Net Income
$7.1 billion
Founded
1963
5 Year Trend
+10.5%
Revenue
$268.7 billion
NASDAQ

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