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
40Time Type
Full timePay Range
The typical pay range for this role is:
$54,300.00 - $159,120.00This 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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- Minimum of 5 years healthcare network management experience, including managing statewide and multi-state networks, completing regulatory state filings, ensuring network adequacy, and overseeing pharmacy operations.
- Minimum of 3 years designing performance measurement frameworks and generating comprehensive analytical reports to track trends and provide actionable insights.
- 2-3 years applying pharmacy regulations and compliance requirements, including network adequacy standards, provider credentialing, state filings, and audit preparation.
- Minimum of 2 years demonstrating strong communication and relationship management skills to build stakeholder trust and support cross-functional collaboration.
- Ability to work collaboratively with cross-functional teams.
- Bachelor's degree or a combination of education and professional work experience.
- 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.
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
