Network Management – Contracting Business Manager

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

📋 Description

• Deliver analytical, reporting, and operational support for Network Management, Provider Engagement, and Contracting.

• Assist in the preparation, analysis, tracking, and submission of regulatory and accreditation network reporting.

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

• Ensure documentation and supporting evidence are maintained for regulatory compliance and audit readiness.

• Coordinate and monitor initiatives and projects related to the network.

• Assess network adequacy and accessibility in primary care, specialty, behavioral health, and various other provider categories.

• Analyze geographic access, availability, utilization, compliance regulations, out-of-network activities, and network performance metrics.

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

• Assist in the creation and monitoring of action plans based on network analyses.

• Highlight workflow gaps and recurring issues within network and contracting operations.

• Propose and support process improvement solutions aimed at enhancing efficiency, accountability, data accuracy, reporting, and provider experience.

⛳️ Requirements

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

• Familiarity with data governance and quality initiatives.

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

• Proficiency in troubleshooting technical issues, identifying root causes, and ensuring timely resolutions.

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

• Candidates must be residents of the state of Kentucky.

• Travel may be necessary depending on business needs.

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

• Preferred: 3 to 5 years of experience in healthcare, covering claims data formats, risk adjustment methodologies, and provider network management.

• Preferred: Experience in project management, leading cross-functional initiatives, managing timelines and deliverables, coordinating stakeholders, and ensuring project completion.

• Preferred: Ability to resolve complex technical challenges by tracing data from generation and ingestion to systems and reporting.

• Preferred: Proficiency in SQL, including the ability to write queries for investigation, root cause analysis, and accurate reporting logic.

• 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.

• CVS Health bonus, commission, or short-term incentive program alongside base pay.