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Role SummaryThe Senior Manager, Medicaid Implementations - Provider Data is accountable for leading provider data readiness, execution, and stabilization activities for Medicaid implementations, expansions, and complex provider network initiatives. This role serves as the senior Provider Data implementation lead, ensuring accurate, compliant, and timely provider data configuration to support successful Medicaid go-lives and ongoing operational stability.
The Senior Manager partners closely with Implementation Leadership, Provider Operations, Credentialing, IT, and Health Plan stakeholders to deliver high-quality provider data outcomes across large, medium, and complex Medicaid implementations.
Key ResponsibilitiesMedicaid Implementation Leadership
- Serve as the Provider Data implementation lead for Medicaid new market entries, expansions, de novo networks, and complex program launches.
- Own end-to-end Provider Data readiness from implementation intake through post-go-live stabilization.
- Assess implementation scope and complexity to determine Provider Data staffing, timelines, and execution approach.
- Provide strategic guidance and risk mitigation planning for provider data impacts across implementations.
Provider Data Execution & Readiness- Oversee provider data build, validation, and reconciliation activities to ensure accuracy, completeness, and regulatory compliance.
- Ensure provider data is configured to support claims, encounters, directories, and state reporting requirements.
- Lead cross-functional issue resolution related to provider data defects, pends, or readiness risks during implementation.
- Drive root-cause analysis for recurring provider data issues and implement corrective actions.
People & Team Leadership- Lead and mentor Provider Data Managers and project resources assigned to Medicaid implementations.
- Establish clear performance expectations, workload prioritization, and accountability across implementation teams.
- Ensure consistent execution standards and best practices across all Provider Data implementation efforts.
Stakeholder & Cross-Functional Partnership- Act as the primary Provider Data liaison to Medicaid Implementation leadership, IT, Credentialing, Network, and Health Plan partners.
- Communicate implementation status, risks, and mitigation plans to senior leadership.
- Influence decisions related to provider data timelines, scope, and readiness criteria.
Process Improvement & Standardization- Contribute to the development and evolution of standardized Provider Data implementation playbooks and workflows.
- Identify opportunities to reduce manual effort, improve data quality, and streamline implementation processes.
- Support enterprise initiatives related to provider data standardization and scalability.
Required Qualifications- 7+ years of experience in Medicaid provider data, provider operations, or healthcare implementations.
- 3+ years of people leadership experience at the Manager or Senior Manager level.
- Deep understanding of Medicaid provider data requirements, including network builds, expansions, and state-specific nuances.
- Demonstrated experience leading complex, cross-functional initiatives in a fast-paced environment.
- Strong analytical, problem-solving, and executive communication skills.
Preferred Qualifications- Experience supporting large or de novo Medicaid implementations.
- Familiarity with provider data systems (e.g., QNXT or similar platforms).
- Experience working with provider directories, claims impacts, and regulatory compliance requirements.
- Proven ability to influence without authority across enterprise teams.
Pay RangeThe typical pay range for this role is:
$75,400.00 - $165,954.00
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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
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We anticipate the application window for this opening will close on: 02/28/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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