Network Management & Contracting Business Manager (Kentucky)
About The Position
This is an individual contributor role providing analytical, reporting, and operational support across Network Management, Provider Engagement, and Contracting. 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 related to network strategy, provider relationships, contracting, compliance, and operational priorities. Candidates must reside in Kentucky. Travel may be required based on business needs, including for meetings, training, client engagements, and other company-related events.
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 to 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 successful completion.
- Ability to solve complex technical problems by tracing data from generation and ingestion through systems and reporting.
- SQL proficiency, with experience writing queries for investigation, root cause analysis, and defining precise reporting logic.
Responsibilities
- Support preparation, analysis, tracking, and timely submission of required 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 ongoing 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 the 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.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
- Eligible for a CVS Health bonus, commission, or short-term incentive program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
