Network Management & Contracting Business Manager (Kentucky)

CVS Health•Somerset, KY

About The Position

This is an individual contributor role supporting Network Management, Provider Engagement, and Contracting functions through analytical, reporting, and operational work. The position serves as a centralized resource for network performance, regulatory and accreditation reporting, provider data, network adequacy, audit readiness, and key initiatives. It analyzes complex information, identifies trends and risks, and delivers actionable insights to support decisions involving network strategy, provider relationships, contracting, compliance, and operational priorities. The role supports required state, regulatory, and accreditation-related network reports, maintains documentation and supporting evidence for audit readiness, and coordinates network-related projects and enterprise initiatives. It analyzes network adequacy and accessibility across provider types, evaluates access and performance indicators, identifies gaps and risks, and supports action plans. It also identifies operational issues and process-improvement opportunities and supports implementation and measurement of improvements. Candidates must reside in Kentucky. Travel may be required based on business needs, including meetings, training sessions, client engagements, and other company-related events. The position is full-time, with 40 anticipated weekly hours. The pay range is $54,300 to $119,340, and the role is eligible for a CVS Health bonus, commission, or short-term incentive program. The full-time position is eligible for benefits including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, subject to eligibility.

Requirements

At least 5 years of experience as a Business Analyst, Data Analyst, or data-focused Product Owner, with exposure to data governance and quality initiatives.
Ability to quickly learn and navigate complex systems, applications, and data structures; troubleshoot technical issues, identify root causes, and drive timely resolution.
Ability to prioritize competing work based on business and client needs and explain prioritization decisions to influence prioritization.
Must reside in the state of Kentucky.
Strong proficiency in Microsoft Office Suite, including Excel, Word, and PowerPoint.
Bachelor’s degree or equivalent combination of education and professional experience.

Nice To Haves

3 to 5 years of healthcare experience, including hands-on experience with core concepts and data such as claims data formats, risk adjustment methodologies, and provider network management.
Prior project management experience, including leading cross-functional initiatives, managing timelines and deliverables, coordinating stakeholders, and driving projects to completion.
Ability to solve complex technical problems by tracing data from generation and ingestion through systems and reporting.
SQL proficiency, including experience writing queries for investigation, root cause analysis, and defining precise reporting logic.

Responsibilities

Support preparation, analysis, tracking, and timely submission of state, regulatory, and accreditation-related network reports.
Monitor reporting requirements, findings, approvals, corrective actions, and related committee activities.
Maintain documentation and supporting evidence to promote regulatory and audit readiness.
Coordinate and monitor network-related projects and enterprise initiatives affecting providers, contracting, provider data, and network operations.
Analyze network adequacy and accessibility across primary care, specialty, behavioral health, and other provider types.
Evaluate geographic access, availability, utilization, compliance regulations, out-of-network activity, and other network performance indicators.
Identify potential network gaps, trends, risks, and opportunities for improvement.
Support development and monitoring of action plans resulting from network analyses.
Identify recurring issues, workflow gaps, and opportunities to improve network and contracting operations.
Recommend solutions that enhance efficiency, accountability, data accuracy, reporting, and provider experience.
Support implementation and measurement of process-improvement initiatives.