Manager Aetna Case Management Jobs (NOW HIRING)

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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.

Major 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.

Required Qualifications:

• 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.

Preferred Qualifications:

• 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.

Education:

• Bachelor's Degree preferred or a combination of education and professional work experience.

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $54,300.00 - $159,120.00

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.