Pharmacy Network Analytics & Compliance Manager

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Retirement savings options

Job summary

CVS Health is seeking a Pharmacy Network Manager to support the Director of Network Pharmacy, ensuring efficient operation of the pharmacy network. The role involves data aggregation, analytics, and reporting, with emphasis on performance measures, stakeholder management, and addressing fraud, waste, and abuse within the network.

This individual contributor position requires collaboration across cross-functional teams, budget involvement, and deep knowledge of healthcare regulations.

Qualifications

• Minimum of 5 years of healthcare network management experience with statewide/multi‑state networks and regulatory filings.
• Minimum of 3 years designing performance measurement frameworks and generating analytical reports.
• 2–3 years applying pharmacy regulations and audit preparation to support compliant network operations.
• Minimum of 2 years demonstrated strong communication and stakeholder relationship skills.
• Ability to collaborate with cross‑functional teams across the enterprise.

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 to support strategic decision‑making.
• Manage relationships with internal stakeholders to ensure alignment and effective communication.
• Monitor pharmacy performance and ensure adherence to quality standards.
• Contribute to budget planning and financial performance analysis of the network.
• Support quality improvement initiatives to enhance service delivery.
• Ensure compliance with federal, state, and local regulations.

Skills

Healthcare network management

Data analysis

Regulatory compliance

Stakeholder communication

Cross-functional collaboration

Education

Bachelor's degree preferred

Tools

Excel

Power BI

Job description

CVS Health is seeking a Pharmacy Network Manager to support the Director of Network Pharmacy, ensuring efficient operation of the pharmacy network. The role involves data aggregation, analytics, and reporting, with emphasis on performance measures, stakeholder management, and addressing fraud, waste, and abuse within the network.

This individual contributor position requires collaboration across cross-functional teams, budget involvement, and deep knowledge of healthcare regulations.