Sr Manager Network Business Ops & Program Management

GuideWell; Northern (KY); Hybrid; USD 109,000 - 178,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Disability coverage

Paid time off

Retirement match

Wellness program

Job summary

GuideWell, a Florida Blue partner, seeks a Sr. Manager of Network Business Operations & Program Mgmt to lead multiple teams and advance strategic initiatives in network development, management, and operations.

The role emphasizes sustainable program development, cross-functional execution, and regulatory compliance across CMS, NCQA, and AHCA, with accountability for budgets up to approximately $3.5 million per project.

Qualifications

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

Responsibilities

• Develop and implement network management strategy aligned with organizational goals.
• Own end-to-end accountability for a portfolio of programs with cross-functional impact.
• Lead complex initiatives with budget accountability up to $3.5M per project.
• Recruit, motivate, and develop multi-functional teams to meet CPI goals.
• Ensure regulatory compliance across CMS, NCQA, AHCA and related filings.

Skills

Strategic leadership

Portfolio management

Regulatory compliance

Stakeholder communication

Team leadership

Budget management

Education

Bachelor’s degree

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, including executive leaders
• Ability to balance innovation with operational feasibility, scalability, provider experience, regulatory requirements, and measurable business outcomes.

What We Require

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

General Physical Demands

• 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).

What We Offer

As a Florida Blue employee, you will be at the heart of GuideWells 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 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

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Typical Annualized Offer/Hiring Range:

$109,300 - $136,600

Annualized Salary Range: $109,300 - $177,600

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.