Network Management – Contracting Business Manager

This is a fully remote position, open to applicants in Kentucky.

📋 Description

• Deliver analytical, reporting, and operational assistance across Network Management, Provider Engagement, and Contracting functions.

• Aid in the preparation, analysis, tracking, and submission of network reports related to state, regulatory, and accreditation requirements.

• Oversee reporting obligations, findings, approvals, corrective measures, and committee activities.

• Ensure the maintenance of documentation and supporting evidence for regulatory compliance and audit readiness.

• Coordinate and supervise network-related projects and enterprise initiatives.

• Examine network adequacy and accessibility across various provider types.

• Assess geographic access, availability, utilization, adherence to compliance regulations, out-of-network activity, and network performance metrics.

• Identify gaps, trends, risks, and opportunities for improvement within the network.

• Assist in the development and monitoring of action plans.

• Recognize workflow deficiencies and enhance network and contracting operations.

• Propose and assess process improvement initiatives.

⛳️ Requirements

• 5 years of experience as a Business Analyst, Data Analyst, or Data-centric Product Owner.

• Background in data governance and quality initiatives.

• Capability to navigate complex systems, applications, and data structures.

• Proficient in troubleshooting technical issues, identifying root causes, and facilitating timely resolutions.

• Ability to prioritize competing tasks based on business and client requirements.

• Must be a resident of Kentucky.

• Travel may be necessary based on business needs.

• Strong skills in Microsoft Office Suite, including Excel, Word, and PowerPoint.

• 3 to 5 years of healthcare experience, particularly in claims data formats, risk adjustment methodologies, and provider network management (preferred).

• Previous project management experience (preferred).

• Capability to trace data from generation and ingestion to systems and reporting (preferred).

• SQL proficiency, including the ability to write queries for investigation, root cause analysis, and reporting logic (preferred).

• Bachelor's degree, or an equivalent combination of education and professional experience.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.