Pharmacy Network Manager (Aetna)
About The Position
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.
Requirements
- 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.
Nice To Haves
- 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.
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.
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
