Sr Manager Network Business Ops & Program Management

Florida Blue • FL, FL

1d • $109,300 - $177,600

About The Position

The Sr. Manager of the Network Business Operations & Program Mgmt. is accountable to lead one or more teams in achieving targeted outcomes/results and capabilities for key strategic initiatives in support of network development, network management and network operations. This position is accountable for implementing sustainable and scalable programs and/or capabilities to ensure best in class Network Management practices with the intent of operational excellence while upholding compliance regulations imparted by multiple regulatory agencies including CMS, AHCA, and NCQA as well as compliance with the Blue Cross Blue Shield Association (BCBSA). This role will be required to work in a fast-paced environment while focusing on the management of multiple projects and/or programs that cross multiple workstreams.

Requirements

• 6+ years related work experience
• 3+ years direct supervisory/management experience
• Related Bachelor’s degree or additional related equivalent work experience

Nice To Haves

• Master’s degree
• In depth knowledge of the health industry
• Broad business experience and knowledge that spans multiple business functions, preferable in the health industry
• Strong problem-solving skills
• Effective interpersonal skills with a demonstrated ability to develop and maintain strong and effective business relationships
• Ability to act in a strong consultative and influencer role across all levels of leadership, including executive leaders

Responsibilities

• Develop and implement network management business strategy aligned with organization-wide goals
• Own end-to-end accountability for a portfolio of programs, projects, and business processes with cross-functional impact (Operational, Product, Legal, IT, Compliance)
• Lead complex, major initiatives supporting both tactical and strategic objectives with budget accountability up to ~$3.5M per project
• Lead and develop multi-functional teams to execute operational plans and CPI goals
• Recruit, motivate, and assess staff performance; build high-performing teams
• Provide tactical and strategic execution across division and unit levels
• Ensure implementation of sustainable programs maintaining best-in-class Network Management practices and regulatory compliance
• Lead Network Regulatory Compliance activities: quarterly/annual filings (CMS, NCQA, AHCA), certifications, product/network filings, NSA processes (IDR, COC), and audit coordination
• Monitor Network Adequacy; coordinate with Network Management on gaps and remediation
• Present network metrics, recommendations, and deliverables to executive leadership on transformational projects
• Communicate across internal and external audiences; influence stakeholder decisions
• Coordinate Product and Network Management interests for emerging product lines
• Maintain Provider Manual, Network SOPs, desktops, and job aid library
• Coordinate Product BRS reviews and manage provider-specific requests (roster validation, vendor reporting)
• Lead development and implementation of playbook documentation as enterprise-wide reference for network programs
• Support Sales RFI/RFP responses for large groups and agents
• Manage reporting activities (Compliance, Expansions, Network Adequacy, Member Re-assignments)
• Lead Network Operations information sessions on new programs and initiatives

Benefits

• Medical, dental, vision, life and global travel health insurance
• Income protection benefits: life insurance, short- and long-term disability programs
• Leave programs to support personal circumstances
• Retirement Savings Plan including employer match
• Paid time off, volunteer time off, 10 holidays and 2 well-being days
• Additional voluntary benefits available; and a comprehensive wellness program
• Competitive pay
• Opportunities for incentive or commission compensation
• Regular annual reviews with pay for performance considerations for base pay increases

What This Job Offers

• Job Type: Full-time
• Career Level: Manager