Pharmacy Network Analytics & Compliance Lead

Hispanic Alliance for Career Enhancement; Tennessee; Hybrid; USD 54,300 - 159,120; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Other benefits

Job summary

CVS Health is seeking a Pharmacy Network Manager to support the Director of Network Pharmacy in ensuring efficient operation of the pharmacy network. This role emphasizes data aggregation, analytics, and reporting to develop performance measures, manage relationships, and address fraud, waste, and abuse.

The position requires 5+ years in healthcare network management, strong MS Excel and Power Query skills, and proven cross-functional collaboration.

Qualifications

• 5+ years healthcare network management experience across statewide and multi-state networks.
• 3+ years designing performance measurement frameworks with actionable insights.
• 2-3 years applying pharmacy regulations and compliance requirements.
• Strong communication and relationship management skills with stakeholders.
• Ability to work collaboratively with cross-functional teams.

Responsibilities

• Aggregate and analyze data to produce detailed reports and respond to audits.
• Develop performance measures for pharmacy network contracts.
• Identify and flag potential fraud, waste, and abuse in the pharmacy network and recommend interventions.
• Collaborate with cross-functional teams to support strategic decision-making.
• Manage relationships with internal stakeholders to ensure alignment and communication.
• Support the Director of Network Pharmacy in monitoring performance and quality standards.
• Assist in budget planning and financial performance analysis of the pharmacy network.
• Contribute to quality improvement initiatives to enhance service delivery.
• Ensure compliance with federal, state, and local regulations.

Skills

Network management

Performance metrics

Regulatory compliance

Stakeholder communications

Cross-functional collaboration

Education

Bachelor's degree preferred

Tools

Excel

PivotTables

Power Query

VBA

Job description

CVS Health is seeking a Pharmacy Network Manager to support the Director of Network Pharmacy in ensuring efficient operation of the pharmacy network. This role emphasizes data aggregation, analytics, and reporting to develop performance measures, manage relationships, and address fraud, waste, and abuse.

The position requires 5+ years in healthcare network management, strong MS Excel and Power Query skills, and proven cross-functional collaboration.