Lead Director, Provider Data Governance (Medicaid)

$100,000 - $231,540/Yr

CVS Health - Blue Bell, PA

Full-time - Senior

Blue Bell, PA

Health and Personal Care Retailers

About the position

The Lead Director, Provider Data Governance at CVS Health is responsible for developing and refining the provider data strategy for Aetna's government programs. This role ensures the integrity and accuracy of provider data, which is essential for seamless healthcare access for members. The position involves creating governance processes, collaborating with cross-functional teams, and aligning policies with organizational goals to enhance data quality and compliance.

Responsibilities

• Collaborate with various teams to understand data requirements and ensure accuracy of provider data throughout its lifecycle.
• Establish and enforce policies for the collection, maintenance, and dissemination of provider data, ensuring compliance with regulations.
• Develop and implement data quality standards and processes to maintain provider information integrity.
• Execute strategies for continuous improvement in data quality, increasing automation and reducing manual workarounds.
• Align data governance practices with organizational goals by working closely with internal stakeholders.
• Identify and mitigate risks related to provider data accuracy in collaboration with Compliance.
• Define KPIs for provider data governance and report on the effectiveness of data management initiatives.
• Utilize data-driven insights to improve provider data governance processes.
• Partner with leaders on new products/strategies to ensure proper consideration of provider data elements.

Requirements

• 10+ years of experience in managed care, network, or health insurance industry, specifically in Medicaid.
• Demonstrated experience in driving change in complex organizations.
• Strong relationship management skills at senior levels, with the ability to build and maintain credible relationships.
• Experience with enterprise-wide and cross-functional large-scale initiatives.
• Demonstrated leadership in business process, project management, and strategic planning.
• Strong quantitative skills to analyze and interpret data, identifying trends and drawing conclusions.
• Ability to create processes in ambiguous situations and deliver results.

Nice-to-haves

• Experience in large scale core platform migrations/integrations.
• Knowledge of QXNT.

Benefits

• Full range of medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Employee Stock Purchase Plan.
• Fully-paid term life insurance plan.
• Short-term and long-term disability benefits.
• Well-being programs and education assistance.
• Free development courses.
• CVS store discount and discount programs with partners.
• Paid Time Off (PTO) and paid holidays.