Lead Director, Provider Data Governance (Medicaid)

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

The Lead Director, Provider Data Governance will develop, enhance, and refine the provider data strategy for Aetna's rapidly growing government programs segments. This position will be responsible for supporting strategic design and ensuring the end-to-end integrity and accuracy of provider data that is critical for seamless access to healthcare services for our government programs members. This role creates and maintains the provider data governance processes and rules to ensure all provider information is accurately recorded and maintained to provide for proper reimbursement and member access (e.g., directory listings). Aligns policies and procedures for the Provider Data Governance department with organizational goals.

This position will require continuous collaboration and consultation with complex, cross-functional stakeholder management, to ensure the desired business outcome is defined and achieved. The ideal candidate is an initiative-taker, detail-oriented, solution-oriented, highly organized and must exhibit strong communication and process improvement skills, with a deep understanding of government programs products, network configurations and regulatory requirements.

Key Responsibilities:

• Collaborate with Network Contracting, Credentialing, Provider Data Services, IT, Digital, Claim Operations, and other cross functional teams to understand data requirements, workflows, and systems to ensure the accuracy of provider data throughout the entire lifecycle.

• Establish and enforce policies and procedures for the collection, maintenance, and dissemination of provider data, ensuring compliance with industry regulations and best practices.

• Develop and implement robust data quality standards and processes to maintain the accuracy and integrity of provider information.

• Develop and execute strategies for continuous improvement in data quality and accuracy, increasing automation and reducing manual workarounds.

• Work closely with internal stakeholders, including IT, Compliance, Network, Service Operations, Product, and Analytics & Behavior Change to align data governance practices with organizational goals and objectives.

• Identify and mitigate risks related to provider data accuracy, collaborating with Compliance to ensure adherence to regulatory requirements.

• Define key performance indicators (KPIs) for provider data governance and regularly report on effectiveness of data management initiatives.

• Utilize data-driven insights to drive improvements in provider data governance processes.

• Partner with cross-functional leaders as new products/strategies are brought to market, ensuring provider data elements are appropriately considered and developed.

Required Experience:

• 10+ years managed care / network / health insurance industry experience, specifically in Medicaid.

• Demonstrated experience successfully driving change in complex organizations.

• Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously.

• Experience with enterprise-wide and/or cross-functional large-scale initiatives with high degree of complexity.

• Demonstrated leadership with relevant initiatives: Business process, enterprise business project management/consulting, and/or strategic planning.

• Strong quantitative skills with ability to structure, analyze, and interpret data to identify trends and draw logical conclusions; propensity toward supporting hypothesis with strong quantitative and qualitative evidence.

• Comfort with ambiguity, ability to create a process where one doesn't exist and deliver results

Preferred Experience :

• Experience in large scale core platform migrations / integrations.

• Knowledge of QXNT.

Education:

• Bachelor's degree or equivalent professional work experience.

Pay Range

The typical pay range for this role is

$100,000.00 - $231,540.00

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (~~~)

We anticipate the application window for this opening will close on: 12/21/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.