Pharmacy Network Analytics & Compliance Specialist

Hispanic Alliance for Career Enhancement; Nevada (IA); 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

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, reporting, and compliance with regulations.

You will develop performance measures, manage stakeholder relationships, and identify opportunities to improve network performance while addressing fraud, waste, and abuse. This full-time role includes comprehensive benefits.

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.
• Minimum of 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.
• Minimum of 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 analysis

Regulatory compliance

Stakeholder management

Cross-functional collaboration

Education

Bachelor's Degree preferred

Tools

Excel

Power Query

PivotTables

VBA macros

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, reporting, and compliance with regulations.

You will develop performance measures, manage stakeholder relationships, and identify opportunities to improve network performance while addressing fraud, waste, and abuse. This full-time role includes comprehensive benefits.