Manager, Network & Operations

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🔥 2 minutes ago

🐊 Florida, Illinois, +3 more states – Remote

🐊 Florida – Remote 🌽 Illinois – Remote 🦞 Maine – Remote 🌲 North Carolina – Remote 🔔 Pennsylvania – Remote

💵 $60.3k - $132.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🌐 Network Operations

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• The Network Manager is responsible for supporting and enhancing national provider networks for Gene, Cellular and Innovative Therapies (GCIT®) and Institutes of Excellence (IOE®) transplant services and operations • Serve as a subject matter expert in contract implementation, network operations, managing complex contract data, ensuring accuracy and alignment with organizational goals and supporting provider recruitment and negotiation activities • Involves collaborating across clinical, legal, sales, and network teams to align strategies and improve network performance • Focuses on maintaining high-quality, accessible, and cost-effective networks while tracking and reporting program performance • Plays a key part in expanding access to innovative, life-changing treatments through strong operational execution and cross-functional coordination

🎯 Requirements

• 5+ years of experience in a health insurance/healthcare environment • 2+ years working knowledge of SCM Web Application and familiarity with the documents housed in SCM and Aetna contract systems • 3-5 years contract implementation, network operations, negotiation, provider data service, provider relations, and/or claims experience • Strong communication, customer service, critical thinking, problem resolution and interpersonal skills • Proven ability to collaborate cross-functionally to support provider network management initiatives • Demonstrated ability to manage multiple projects simultaneously, work independently as well as in a team environment and cross functionally across the broader organization • General knowledge of provider compensation methods, coding and billing (per diems, case rates, stop loss, revenue codes, DRGs, CPT-4) • Experience in healthcare network management, provider contracting, and managed care reimbursement • Understanding of 340B drug pricing, AWP and WAC drug reimbursement methodologies as well as global bundled contracting arrangements • Strong working knowledge of healthcare business segments, products, and industry terminology • Excellent communication skills, with experience handling complex provider relationships and operational issues • Systems knowledge: Quickbase, Excel, Adobe sign

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • comprehensive benefits package designed to support physical, emotional, and financial well-being