Pharmacy Network Analytics & Compliance Manager

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

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is hiring a Pharmacy Network Manager to support the Director of Network Pharmacy, focusing on data aggregation, analytics and reporting for the pharmacy network. This is an individual contributor role located in the United States with responsibilities spanning contract performance, fraud prevention and regulatory compliance.

Ideal candidates will bring 5+ years in healthcare network management, 3+ years designing performance metrics, and 2+ years of regulatory experience, with

Qualifications

• 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.
• 3+ years of experience designing performance measurement frameworks and generating comprehensive analytical reports, with demonstrated ability to track performance trends, identify improvement opportunities, and provide actionable insights to stakeholders.
• 2-3 years of experience applying pharmacy regulations and compliance requirements, including network adequacy standards, provider credentialing, state filings, and audit preparation, to support compliant pharmacy network operations.
• 2+ years of experience demonstrating strong communication and relationship management skills, with a proven ability to build and maintain stakeholder trust, foster cross-functional collaboration, and contribute to successful project delivery and operational outcomes.

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

Data analytics

Stakeholder management

Communication

Regulatory compliance

Education

Bachelor's degree

Tools

Excel

PivotTables

Power Query

Job description

CVS Health is hiring a Pharmacy Network Manager to support the Director of Network Pharmacy, focusing on data aggregation, analytics and reporting for the pharmacy network. This is an individual contributor role located in the United States with responsibilities spanning contract performance, fraud prevention and regulatory compliance.

Ideal candidates will bring 5+ years in healthcare network management, 3+ years designing performance metrics, and 2+ years of regulatory experience, with