Pharmacy Network Manager (Aetna)

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. Aetna is seeking a Manager, Network Pharmacy 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 3 years of experience in network management. Experience in developing performance measures and producing detailed reports. Knowledge of pharmacy regulations and compliance. Excellent communication and relationship management skills. 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. 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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit Benefits | CVS Health We anticipate the application window for this opening will close on: 04/12/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area. Apply Job!