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CVS Health · 1 day ago

Network Audit Program Manager

United States

Full-time

Remote

Mid Level

$47K/yr - $112K/yr

3+ years exp

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care. The Network Audit Program Manager will oversee the network audit team, ensuring compliance and performance metrics while supporting the development of a market-specific provider network.

Health CareMedicalPharmaceuticalRetailSales

Responsibilities

Support the development and execution of results-driven programs and innovative initiatives within the network audit area, operating under general supervision

Coordinates and supports the network contracting lifecycle including but not limited to intake and evaluation of provider network applications, agreement execution, and enablement of provider credentialing and load for claims processing

Employ strategic thinking in departmental initiatives by aligning projects with organizational objectives, contributing to strategy development, and utilizing data analysis to support informed decision-making. Demonstrate the ability to address complex challenges, create innovative solutions, and approach existing issues from new perspectives

Identifies trends impacting service delivery and works collaboratively with appropriate parties to recommend enhancements or solutions that address potential challenges, including improving management controls, tightening procedures, or fulfilling training needs

Utilizes recruitment and audit applications and contract management systems to audit complex provider network applications which may include agreements, amendments, and fee schedules for individuals and groups wanting to participate in Aetna’s provider network

Performs audits to verify compliance ensure adherence to performance standards, ensuring superior outcomes in quality, accuracy, and timeliness

Offers technical expertise and subject matter knowledge regarding policies, procedures, and network audit applications and system tools

Prepares and presents project progress updates, emphasizing accomplishments, risks, and mitigation measures. Demonstrating strong communication and presentation skills to effectively convey information to varied audiences

Cultivates relationships with internal teams and external clients to enhance departmental results

Promotes a culture of trust by promptly identifying risks and dependencies, enabling timely mitigation or strategic responses

Offers continuous feedback and serves as a subject matter expert in resolving procedural challenges

Mentor audit staff on work procedures, ensuring compliance with established audit processes and maintaining high-quality standards

Delivers training to network audit personnel

Qualification

Managed healthcare contractingNetwork managementProject managementSharePointMedicaid experienceQuickBaseExcelComplex problem-solvingMulti-taskingTraining deliveryCross-functional teamworkDecision-making skillsCommunication skills

Required

3-5 years of experience working in managed healthcare contracting, network management, or supporting roles

1-2 years project management experience

SharePoint experience (Manage and build out)

Medicaid experience

QuickBase, Excel (Pivot tables, Basic formulas) experience

Bachelor' Degree or equivalent work experience (HS diploma + 4 years relevant experience)

Preferred

3-5 years of experience with collaboration and cross-functional teamwork

3-5 years of experience with multi-tasking and prioritizing duties

3-5 years of experience with complex problem-solving and decision-making skills

Benefits

Affordable medical plan options

401(k) plan (including matching company contributions)

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.