Sr. Manager, Provider Data and Network Operations

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.

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.

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.

• 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

• 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 

• 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

• 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

• 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

• Manage and develop one to two analysts into strong data and network-operations practitioners

• 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

• Radiating positive energy

• Assuming good intentions

• Driving clinical excellence

• Taking ownership and delivering results

• Being relentlessly determined

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.

The typical pay range for this role is: