Network Operations Representative Jobs (NOW HIRING)

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Position Summary

The Network Manager is responsible for supporting and enhancing national provider networks for Gene, Cellular and Innovative Therapies (GCIT) and Institutes of Excellence (IOE) transplant services and operations. This role serves as a subject matter expert in contract implementation, network operations, managing complex contract data, ensuring accuracy and alignment with organizational goals and supporting provider recruitment and negotiation activities. It involves collaborating across clinical, legal, sales, and network teams to align strategies and improve network performance. The position focuses on maintaining high-quality, accessible, and cost-effective networks while tracking and reporting program performance. Overall, the role plays a key part in expanding access to innovative, life-changing treatments through strong operational execution and cross-functional coordination.

The ideal candidate is a highly motivated selfstarter who excels in a fastpaced, crossfunctional environment with knowledge of contracting methodologies, provider relations, database management, and contract compliance.

Key Responsibilities

• Serve as a subject matter expert in provider contract setup demonstrating a strong understanding of Strategic Contract Management (SCM).
• Manage and process contract documents and data to ensure accuracy, compliance, and integrity.
• Administer Quick Base database tracking and reporting activities, support ACAS table maintenance, EDPB provider flagging and provider directory processes.
• Collaborate with clinical, legal, sales, and network teams to drive aligned execution and program success.
• Serve as the primary point of contact for the Special Case Customer Service Unit (SCCU), National Medical Excellence (NME), and other internal and external stakeholders related to IOE and GCIT operations.

• Partner with IOE/GCIT network contracting teams to negotiate and establish contractual terms and conditions with network providers, ensuring alignment with organizational goals and objectives.
• Support negotiations of nonparticipating gene/cellular therapy and transplant services including drafting and processing singlecase agreements, while adhering to cost parameters and ensuring savings achievement initiatives (SAI).

• Track, analyze, and report on network performance and program metrics.
• Partner cross-functionally with the National Medical Excellence (NME) and Specialty Precertification Unit (SPU) clinical teams and other departments (MEU, SCCU, Legal, Compliance, Account Management, etc.) to drive consistent strategies and processes.

Required Qualifications

• 5+ years of experience in a health insurance/healthcare environment.
• 2+ years working knowledge of SCM Web Application and familiarity with the documents housed in SCM and Aetna contract systems.
• 3-5 years contract implementation, network operations, negotiation, provider data service, provider relations, and/or claims experience.
• Strong communication, customer service, critical thinking, problem resolution and interpersonal skills.
• Proven ability to collaborate cross-functionally to support provider network management initiatives.
• Demonstrated ability to manage multiple projects simultaneously, work independently as well as in a team environment and cross functionally across the broader organization.

Preferred Qualifications

• General knowledge of provider compensation methods, coding and billing (per diems, case rates, stop loss, revenue codes, DRGs, CPT-4).
• Experience in healthcare network management, provider contracting, and managed care reimbursement.
• Understanding of 340B drug pricing, AWP and WAC drug reimbursement methodologies as well as global bundled contracting arrangements.
• Strong working knowledge of healthcare business segments, products, and industry terminology.
• Excellent communication skills, with experience handling complex provider relationships and operational issues.
• Systems knowledge: Quickbase, Excel, Adobe sign

Education
Bachelor's degree preferred/specialized training/relevant professional qualifications

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,300.00 - $132,600.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

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 fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing 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.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 09/07/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.