Senior Manager, Provider Data and Network Operations

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Take charge of the eligibility methodology that identifies which specialists and facilities qualify for the Preferred Network.

• Oversee the regular network refresh process as vendor scoring data is updated.

• Manage the insurance-plan crosswalk for internal validation and modifications to insurance records.

• Evaluate the geographical reach of the Preferred Network and its alignment with insurance networks.

• Redesign the technical pipeline for network adequacy analysis following the Epic migration.

• Maintain processes for the accurate entry and upkeep of specialist and facility data in Epic.

• Collaborate with Provider Data Management, engineering, and informatics teams on data-source design and issue resolution.

• Address provider and facility data concerns raised through field-reported complaints.

• Manage vendor relationships related to claims-based network scoring and provider-directory data.

• Oversee contract performance, data quality challenges, and vendor roadmap contributions.

• Lead the internal provider-data verification collaboration, including scope, frequency, and necessary corrections.

• Manage and mentor one to two analysts, fostering their development as proficient data and network operations professionals.

• Collaborate with the Sr. Manager responsible for referral optimization and network utilization.

⛳️ Requirements

• Minimum of 5 years of experience in healthcare data or network operations, provider data management, or a closely related analytics role.

• Strong preference for candidates with a background in value-based care, Medicare Advantage, or health plan/health system network operations.

• Direct, hands-on experience managing provider or facility directory data on a large scale.

• Proven track record of owning processes for validating, correcting, or maintaining provider/facility records.

• Proficient in SQL.

• Demonstrated capability to independently build and maintain data pipelines or workflows.

• Familiarity with tools such as Snowflake, Alteryx, Dataiku, or similar platforms.

• Experience in managing relationships with external vendors and fostering cross-functional internal collaborations.

• Ability to work effectively with incomplete or frequently changing source-of-truth systems.

• Sound judgment regarding when to escalate issues versus when to create alternative solutions.

• Preferred experience with claims-based provider performance or quality scoring methodologies.

• Familiarity with Epic, particularly with Epic-based referral or provider-directory workflows, is preferred.

• Experience in people management, especially in developing early-career analysts, is preferred.

• Preferred background in value-based care or Medicare Advantage network management specifically.

🏝️ Benefits

• A mission-driven career that facilitates change and significantly enhances health outcomes for Medicare patients.

• Paid vacation and sick leave.

• 401K matching options for retirement investment.

• Comprehensive health insurance, including vision and dental coverage.

• Opportunities for leadership development.

• Continuing education stipends available.

• New centers and adaptable work environments.

• Opportunities for substantial responsibilities and swift career advancement.

• Medical, dental, and vision insurance coverage.

• Paid time off benefits.

• Retirement savings options.

• Wellness programs available.

• Additional resources based on eligibility.

• CVS Health bonus, commission, or short-term incentive program.

• Eligibility for awards in the company’s equity award program.