CVS Health
Healthcare, insurance, PBM, and retail pharmacy
Manager – Network Management - National Health Systems
+ Bonus + Commission + Short-term incentive
More locations: Washington, USA | Kansas, USA | Pennsylvania, USA | North Dakota, USA | Oregon, USA | Delaware, USA | Iowa, USA | California, USA | Washington, DC, USA | Vermont, USA | Wyoming, USA | Texas, USA | Montana, USA | Florida, USA | New Hampshire, USA | Nevada, USA | South Carolina, USA | South Dakota, USA | Georgia, USA | Arizona, USA | Mississippi, USA | Tennessee, USA | Virginia, USA | Arkansas, USA | Minnesota, USA | Colorado, USA | Nebraska, USA | Rhode Island, USA | Utah, USA | Hartford, CT, USA | Kentucky, USA | West Virginia, USA | New York, NY, USA | Maryland, USA | Wisconsin, USA | Maine, USA | Massachusetts, USA | North Carolina, USA | Oklahoma, USA | Missouri, USA | Ohio, USA | New Jersey, USA | Indiana, USA | Louisiana, USA | Michigan, USA | Illinois, USA | Alabama, USA | Idaho, USA
About the job
- At least 5 years of provider contracting, claims management, or patient management experience.
- At least 5 years of experience working with or in a claims environment.
- At least 5 years of experience with ACAS and HRP claim platforms, products, and benefits, or with patient management, provider relations, or claims management.
- Construct, execute, review, and analyze contracts.
- Deliver dispute resolution and settlement negotiations with providers.
- Ensure contract performance aligns with accessibility, compliance, quality, financial, and cost goals.
- Develop, maintain, and enhance working relationships with physicians, providers, and local network and patient management teams in Aetna markets.
- Establish and implement programs and innovative initiatives to advance contract negotiations initiatives.
- Forecast changes within the contract negotiations industry, conduct business impact assessments, and develop modification strategies using process improvement methodologies.
- Integrate cross-functional collaboration to contribute to provider compensation and pricing development activities, recommendations for negotiations, and reimbursement modeling activities.
- Determine recommendations to manage cost issues and support cost-saving initiatives and settlement activities.
- Assist in managing network development, maintenance, and refinement activities and strategies supporting cross-market network management units.
- Coach more junior colleagues in techniques, processes, and responsibilities.
- Perform other duties and responsibilities as assigned by the manager.
- Experience with Aetna systems, including SCM, Smart Front End, Rate Inquiry, and Contract Inquiry.
- A bachelor's degree or a combination of professional work experience and education.
About the company
CVS Health operates as a diversified health services company in the United States, organized into Health Care Benefits, Pharmacy & Consumer Wellness, and Health Services. Its offerings include medical insurance products, retail and mail-order prescription drugs, and pharmacy benefit management (PBM) services, all connected through its integrated platform. By combining insurance, retail pharmacy, PBM, and health solutions, CVS Health coordinates care and controls costs across touchpoints for individuals, employers, and government programs. The company aims to lower health care costs while improving access and health outcomes for customers.
Company Size
10,001+
Company Stage
IPO
Headquarters
Woonsocket, Rhode Island
Founded
1963
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Simplify's Take
What believers are saying
- August 5, 2026 CVS raised adjusted EPS guidance to $7.90-$8.10 and revenue to $414 billion.
- Walgreens plans roughly 1,200 U.S. store closures through 2027, sending prescription volume to CVS.
- Teresa Heitsenrether joined the board September 2026, strengthening CVS’s data and digital execution focus.
What critics are saying
- May 2026 340B lawsuits from Mount Sinai, Michigan, and Kansas attack Caremark’s remittance model.
- CVS disclosed 2027 Caremark membership declines and continued 340B pressure on August 5, 2026.
- If courts restrict 340B spreads or rebate flows, CVS loses a core profit engine.
What makes CVS Health unique
- CVS Health combines Aetna, Caremark, and 9,000 pharmacies across one U.S. customer funnel.
- August 5, 2026 results showed integrated pricing, insurance, and pharmacy scale outperformed standalone peers.
- The August 2026 Eli Lilly collaboration embeds Zepbound and Foundayo access inside CVS channels.
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Benefits
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Disability Insurance
401(k) Retirement Plan
Company Equity
Wellness Program
Professional Development Budget
Paid Vacation
Paid Holidays
Company News
CVS Health shares have declined 2.1% over the past three months, prompting investors to consider whether now is an opportune time to buy. The healthcare giant, which operates approximately 9,000 retail pharmacy locations and serves more than 35 million people through its health insurance business, reported second-quarter revenue of $106 billion, up 7.3% year-over-year. Adjusted earnings per share rose 43% in the same period. The company offers a dividend yield of 2.8%, with its annual payout increasing from $2 in 2021 to $2.66 per share recently. Shares currently trade at $95, with one analyst setting a price target of $120. The stock's forward price-to-earnings ratio of 11 sits slightly above its five-year average of 10.
The health insurance industry may have recovered from high medical costs, with analysts predicting strong growth through 2030. Morningstar forecasts 16% annual earnings per share growth for major insurers, above the industry's typical low-double-digit target. Health insurers are improving profitability by raising rates to cover increased medical utilisation. UnitedHealth Group reported over $5 billion in second-quarter net income, with its medical care ratio falling to 86.7% from 89.4% year-over-year. The outlook also improved for pharmacy benefit management operations at companies like UnitedHealth, CVS Health, and Cigna. Despite increased regulatory scrutiny, the "big three" PBMs maintain strong competitive positions. Third-quarter earnings reports next month should provide further clarity on the industry's financial health.
Walgreens is closing roughly 1,200 of its approximately 8,500 US locations through 2027, with many customers being redirected to nearby CVS pharmacies. The pattern is reshaping suburban pharmacy markets without direct competition. In August 2025, Walgreens completed a $10 billion sale to private equity firm Sycamore Partners, taking the 124-year-old chain private for the first time. Mike Motz was named chief executive, replacing Tim Wentworth. CVS is gaining market share without active expansion efforts. Federal and state rules require orderly prescription transfers when pharmacies close, often directing patients to the nearest CVS location. CVS and Walgreens together now handle nearly 40% of all US retail prescription sales. CVS benefits from owning Caremark, a dominant pharmacy benefit manager, providing vertical integration advantages.
CVS Health stock has declined 12.3% over the past month, sitting about 15% below its 52-week high, though it remains up 34% over the trailing twelve months. The company's revenue reached approximately $415 billion, up 7.4% year-over-year. Management raised its full-year 2026 adjusted earnings per share guidance by $0.60 to a range of $7.90 to $8.10. For 2027, the company anticipates membership declines at Caremark and continued 340B programme pressure, offset by Aetna's recovery, which added over $2 billion in adjusted operating income in the first half of 2026. Management considers a 2027 adjusted EPS outlook of at least $8.44 reasonable. Historically, CVS has experienced varied recovery periods following market downturns, with some rebounds taking years rather than months.
CVS Health and Roche could benefit from the growing GLP-1 drug market, alongside current leaders Eli Lilly and Novo Nordisk. CVS Health has improved its financial performance, with second-quarter revenue rising 7.3% year-over-year to $106.1 billion and adjusted earnings per share increasing 42.5% to $2.58. The pharmacy chain offers all approved GLP-1 medicines in the US, including Eli Lilly's Zepbound and Foundayo, plus Novo Nordisk's Wegovy. CVS also provides low-cost online consultations at $29 to assess patient eligibility for GLP-1 drugs. Beyond GLP-1 initiatives, CVS is addressing previous business challenges and is positioned to capitalise on rising healthcare spending in the US over the next decade.