Pharmacy Network Analytics & Compliance Lead

Hispanic Alliance for Career Enhancement; Washington (District of Columbia); Hybrid; USD 54,300 - 159,120; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

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

The role requires experience in healthcare network management, regulatory compliance, and cross-functional collaboration to drive quality and cost-effective

Qualifications

• Minimum of 5 years of healthcare network management experience with demonstrated success in managing statewide and multi-state networks, completing regulatory state filings ensuring network adequacy and compliance, and overseeing pharmacy operations.

Responsibilities

• Aggregate and analyze data to produce detailed reports and respond to audits.
• Develop and implement performance measures for pharmacy network contracts.
• Identify and flag potential fraud, waste, and abuse within the pharmacy network, and recommend interventions.
• Collaborate with cross-functional teams across the enterprise to support strategic decision-making.
• Manage relationships with internal stakeholders to ensure alignment and effective communication.
• Support the Director of Network Pharmacy in monitoring pharmacy performance and ensuring adherence to 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

Healthcare network management

Performance measurement design

Regulatory compliance

Stakeholder communication

Cross-functional collaboration

Budget analysis

Education

Bachelor's degree

Tools

Excel

PivotTables

Power Query

Excel VBA

Job description

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

The role requires experience in healthcare network management, regulatory compliance, and cross-functional collaboration to drive quality and cost-effective