Sr. Manager, Provider Data and Network Operations

Job description

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 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 Why Oak Street Health? Oak Street Health is on a mission to “Rebuild healthcare as it should be'', providing personalized primary care for older adults on Medicare, with the goal of keeping patients healthy and living life to the fullest. Our innovative care model is centered right in our patient’s communities, and focused on the quality of care over volume of services. We’re an organization on the move! With an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody “Oaky” values and passion for our mission. 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 Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply. 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 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.