Senior Manager, Network Operations

L.A. Care Health Plan•Los Angeles, CA

5d•$135,136 - $216,218

About The Position

The Senior Manager of Network Operations leads the planning, implementation, and oversight of managed care programs and specialized initiatives that drive organizational performance and compliance. This role translates complex program and regulatory requirements into actionable operational plans, coordinates cross-functional teams for timely execution, and provides strategic updates to senior leadership. The Senior Manager ensures regulatory guidance is operationalized; monitors program and regulatory compliance and proactively identifies risks and process improvement opportunities. Through data-driven oversight and executive-level reporting, the manager maintains operational excellence, supports audit readiness, and represents Network Operations with professionalism in all internal and external engagements. Manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. Responsible for driving performance to ensure that the team can lead high-level decisions that impact on the success of L.A. Care. Oversee the development, implementation, administration, and maintenance of the department's programs, policies, and procedures. Responsible for driving management and performance to ensure that the team can lead high-level decisions that impact on the success of L.A. Care. Collaborate closely with executive/ senior management to establish goals that align with the company’s mission and vision.

Requirements

At least 7 years of experience in managed care program administration, including end-to-end ownership of planning, implementation, monitoring, and ongoing management of complex initiatives such as targeted rate programs, hospital-directed payments, state and federal payment projects, and provider attestations.
At least 5 years of experience in leading, supervising and/or managing staff.
Experience translating regulatory and program requirements into actionable operational plans, coordinating cross-functional teams, and delivering measurable outcomes.
Experience interpreting and operationalizing regulatory guidance (e.g., All Plan Letters), developing business requirements, leading workgroups, and establishing performance indicators to ensure compliance and audit readiness.
Strong skills in risk identification, executive reporting, and fostering accountability across operational, provider, system, contractual, and communication domains.
Advanced skills in managed care program administration, including the ability to plan, implement, monitor, and manage complex initiatives from inception through ongoing operations.
Ability to translate program and regulatory requirements into actionable operational work plans, establishing clear milestones and deliverables, and fostering accountability for measurable outcomes.
Strong cross-functional leadership skills, with proven ability to coordinate teams and subject matter experts, resolve challenges, and deliver strategic recommendations to senior leadership.
Adept at interpreting and operationalizing regulatory guidance (such as All Plan Letters), developing business requirements, and leading workgroups to ensure compliance.
Risk identification and escalation skills, performance measurement through key indicators, executive-level communication, and consistent professionalism in representing Network Operations across all engagements.
Strong interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment. Ability to guide and support team members.
Excellent ability to set clear goals, develop strategic plans to achieve those goals, and inspire others to work towards a shared vision.
Skilled in mediating disputes and resolving conflicts in a fair and constructive manner.
Must have a deep understanding of financial principles.
Ability and excellent knowledge in developing and managing budgets, forecasting future financial outcomes, and making informed decisions about resource allocation.
Demonstrated ability to make informed decisions.
Strong verbal, written communication and presentation skills.
Deep understanding of the industry, market dynamics, and organizational operations to identify opportunities and navigate challenges.
Strong ability and knowledge to analyze market trends, anticipate future changes, and develop long-term strategies that align with the company's goals.
Travel to offsite locations for work required.

Nice To Haves

Experience in change management, including leading training and communications to drive adoption of new processes, is valued.
Advanced data analysis skills to leverage operational and trend data for identifying emerging risks and process improvement opportunities.
knowledge of provider contracting, payment methodologies, and risk-sharing arrangements such as DOFR-based payments and provider attestations is highly desirable.
Proficiency in developing and maintaining audit-ready documentation and control frameworks, as well as partnering with IT and data teams to translate business requirements into system changes, further enhances effectiveness in this role.

Responsibilities

Drives the success of managed care programs and specialized initiatives that directly impact organizational performance and compliance. Responsible for end-to-end ownership of planning, implementation, monitoring, and ongoing administration of complex programs including targeted rate programs, hospital-directed payments, state and federal payment initiatives, provider attestations, and other network-based projects. By translating program requirements into actionable operational work plans, ensures clarity in milestones, deliverables, ownership, dependencies, and success measures, fostering accountability and measurable outcomes.
Coordinates cross-functional teams and subject matter experts, ensuring timely execution and providing regular status updates and strategic recommendations to the to management. Monitor program requirements, anticipate challenges, and drive solutions that align with organizational goals.
Responsible for interpreting and operationalizing regulatory guidance, including All Plan Letters (APLs) and other directives affecting provider network functions. Through rigorous evaluation and assessment, identifies potential impacts across operational, provider, system, contractual, and communication domains. Translates policy into clear, executable business requirements, developing detailed implementation plans, and leading cross-functional workgroups to ensure deliverables are met. Coordinates monitoring activities to validate execution, identify gaps, and escalate unresolved regulatory risks to senior leadership.
Establishes key performance indicators, identifying performance gaps, implementing targeted action strategies, and conducting ongoing oversight. Leverages data and operational trends to identify emerging risks and opportunities for process improvement, ensuring that Network Operations policies, procedures, workflows, and documentation support compliance and audit readiness.
Manages routine and team matters, escalating material risks or issues requiring executive intervention through concise, executive-level reporting and briefing materials. Promotes early visibility into risks affecting compliance, provider operations, financial performance, or organizational commitments, serving as a representative for Network Operations with professionalism and consistency in all internal and external engagements.
Manages staff and the day-to-day activities in the department. Participates in the department budgeting process. Responsible for scheduling, training, performance, corrective actions, mentoring, and developing of the team(s). Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals. Mentors and develops staff, building technical and problem-solving skills across the team.
Implements and provides guidance to the departmental and organizational processes and policies and works with senior and/or executive management to define, prioritize, and develop projects and programs.
Responsible for Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
Responsible for overseeing and managing the budgets of their respective departments.
Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.
Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities.
Perform other duties as assigned.