Sr Manager Network Business Ops & Program Management

GuideWell • FL, FL

10d • $109,300 - $177,600 • Onsite

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

• Demonstrated experience developing, launching, or transforming innovative and emerging provider programs, rather than solely administering established network programs
• Experienced identifying new approaches to provide engagement, collaboration, performance, or network management and translating concepts into scalable programs and operations solutions
• 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
• Ability to balance innovation with operational feasibility, scalability, provider experience, regulatory requirements, and measurable business outcomes.
• Drive forward thinking approach to provider strategy, identifying opportunities to evolve programs in response to changing provider, member, market, and business needs
• Design, develop, and implement innovative provider programs and capabilities that improve provider engagement, operational effectiveness, and overall network performance
• Evaluate existing provider programs and processes to identify opportunities for modernization, simplification, scalability, and measurable improvement
• Translate emerging business needs, industry trends, and operational insights into future-state strategies and actionable provider solutions

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
• Ensure Network Regulatory Compliance activities: quarterly/annual filings (CMS, NCQA, AHCA), certifications, product/network filings, NSA processes (IDR, COC), and audit coordination
• Ensure 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
• Coordinate initiative BRS reviews and manage provider-specific requests (roster validation, vendor reporting)
• Lead development and implementation of project/program documentation as enterprise-wide reference for network programs
• 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