Senior Manager, Network Compliance

CVS Health

13d

About The Position

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Job Summary The Senior Manager, Network Compliance is responsible for managing business projects and programs, including all aspects of reporting, analysis, and compliance related to network filings to California regulators. In this role, you will: Support the compliance and network teams to execute on strategic advancement of local and national goals. Oversee and manage all network-related filings in DMHC filings, including network adequacy, timely access, and new product filings. This includes material modifications and amendment filings. Examples of specific filings below: annual HMO and PPO network reports new network filings network expansions network withdrawals alternate access filings 10% network termination filings Collaborate with cross-functional teams, including network, legal, operations, market leadership, and external vendors, to ensure alignment and adherence to regulatory requirements. Manage large-scale projects through the project management lifecycle, including scoping, documentation, successful launch, and implementation, and monitoring key performance indicators to measure ongoing success. Conduct regular progress reviews and provide transparent reporting on project performance, value realization, and return on investment (ROI) Exercise sound judgment and critical thinking skills, demonstrate analytical and problem-solving skills.. The successful candidate in this role will exhibit the following: Compile, organize, name and coordinate supporting exhibits and attachments Research provider licensing and NPIs Create/maintain unit reference materials Compile/manipulate reports in Access and other applications Work independently and quickly, with little oversight, as well as in a group Ability to pick up new systems quickly, including e-filing systems Manage competing priorities and meet deadlines

Requirements

• 7+ years’ experience in compliance, network management, or a related field in the healthcare industry
• Advanced proficient in Excel (creating and modifying spreadsheets; sorting, filtering and manipulating data; using formulas and queries)
• Proficiency with the Microsoft Office products, including Word and Teams, as well as Adobe
• Strong organizational skills, communication skills, including communicating status updates as needed

Nice To Haves

• Understanding of California compliance statutes and regulations related to network requirements including but not limited to the Knox Keene Act and Title 28 of the California Code of Regulations.
• Preference is for this candidate to reside in California but not required
• Experience with Aetna systems, EPDB and/or SmartFront End preferred
• Intermediate proficiency with data analysis and reporting tools including Microsoft Access, Microsoft BI, SQL, and Tableau.

Responsibilities

• Support the compliance and network teams to execute on strategic advancement of local and national goals.
• Oversee and manage all network-related filings in DMHC filings, including network adequacy, timely access, and new product filings. This includes material modifications and amendment filings.
• Collaborate with cross-functional teams, including network, legal, operations, market leadership, and external vendors, to ensure alignment and adherence to regulatory requirements.
• Manage large-scale projects through the project management lifecycle, including scoping, documentation, successful launch, and implementation, and monitoring key performance indicators to measure ongoing success.
• Conduct regular progress reviews and provide transparent reporting on project performance, value realization, and return on investment (ROI)
• Exercise sound judgment and critical thinking skills, demonstrate analytical and problem-solving skills.
• Compile, organize, name and coordinate supporting exhibits and attachments
• Research provider licensing and NPIs
• Create/maintain unit reference materials
• Compile/manipulate reports in Access and other applications
• Work independently and quickly, with little oversight, as well as in a group
• Ability to pick up new systems quickly, including e-filing systems
• Manage competing priorities and meet deadlines

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees