Sr Manager Network Business Ops & Program Management at GuideWell

Job description

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. What You Will Be Doing Strategic Leadership & Portfolio Management 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 Team Leadership & Development 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 Compliance & Regulatory Management 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 Stakeholder Communication & Influence 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 Program & Process Administration 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 The Ideal Candidate Will 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 What We Prefer 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, includi