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CVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca
Manager, Network & Operations
Location
Florida + 4 moreAll locations: Florida | Illinois | Maine | North Carolina | Pennsylvania
Posted
5 days ago
Salary
$60.3K - $132.6K / year
Seniority
Senior
Job Description
Manager, Network & Operations
CVS Health
• 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
Job 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
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