Pharmacy Network Manager (Aetna)

CVS Health; Virginia (MN); Hybrid; USD 54,300 - 159,120; Full time

Job summary

CVS Health, in collaboration with Aetna, seeks a Pharmacy Network Manager to support the Director of Network Pharmacy. This role emphasizes data aggregation, analytics, and reporting to develop performance measures and address fraud, waste, and abuse within the network.

The position requires cross-functional collaboration, stakeholder management, and strong regulatory knowledge to ensure compliance and optimal network performance.

Qualifications

• Minimum 5 years of healthcare network management experience with statewide/multi-state networks.
• Minimum 3 years designing performance measurement frameworks and analytics reports.
• 2-3 years applying pharmacy regulations, provider credentialing, and state filings for compliance.
• 2+ years strong communication and relationship management for stakeholder trust.

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.
• Collaborate with cross-functional teams to support strategic decision-making.
• Manage relationships with internal stakeholders for alignment and communication.
• Monitor pharmacy performance and ensure adherence to quality standards.
• Assist in budget planning and financial performance analysis.
• Contribute to quality improvement initiatives.

Skills

Data analysis

Reporting

Stakeholder management

Cross-functional collaboration

Regulatory compliance

Fraud, waste, and abuse awareness

Education

Bachelor's Degree preferred

Tools

Microsoft Excel

PivotTables

Power Query

Excel macros/VBA

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

This is an individual contributor role.

Aetna is seeking a Pharmacy Network Manager to support the Director of Network Pharmacy in ensuring the efficient operation of Aetna's pharmacy network. This role involves data aggregation, analytics, and reporting responsibilities, with a focus on developing performance measures, managing relationships, and addressing fraud, waste, and abuse within the pharmacy network.

Major 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.

Required 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.
• Ability to work collaboratively with cross‑functional teams.

Preferred Qualifications

• Experience in the healthcare or pharmacy industry.
• Experience in identifying and addressing fraud, waste, and abuse in pharmacy services.
• Familiarity with Medicare line of business.
• Advanced proficiency with Microsoft Excel, including formulas, nested functions, PivotTables, and Power Query.
• Experience creating and maintaining Excel‑based reports to support performance tracking and business decision‑making.
• Familiarity with Excel macros/VBA to automate recurring reporting and improve efficiency.
• Candidates located in the Eastern and Central time zones.

Education

• Bachelor's Degree preferred or a combination of education and professional work experience.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,300.00 - $159,120.00

This pay range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Application Window

We anticipate the application window for this opening will close on: 09/14/2026

Equal Employment Opportunity

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.