Sr Manager Network Business Ops & Program Management

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 work streams.

• 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

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

• 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

• Exerting up to 10 pounds of force occasionally to move objects.
• Jobs are sedentary if traversing activities are required only occasionally.
• Must be able to travel occasionally to multiple locations for work (i.e. travel to attend meetings, events, conferences).

As a Florida Blue employee, you will be at the heart of Guide Well’s vision – to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance
• Income protection…