Strategic Network Operations & Programs Leader

GuideWell; Town of Florida (NY); On-site; USD 109,000 - 178,000; Full time

Benefits offered by this job

Medical, dental, vision

Life insurance

Disability coverage

Retirement plan

Paid time off

Job summary

GuideWell, the Florida Blue company, seeks a Senior Manager of Network Business Operations & Program Mgmt to lead teams delivering strategic network initiatives, ensuring regulatory compliance, and driving operational excellence across multiple workstreams.

You will own portfolio management, supervise staff, coordinate with stakeholders, and oversee reporting, vendor interactions, and documentation development for enterprise-wide network programs.

Qualifications

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

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
• 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
• Demonstrate experience developing, launching, or transforming innovative and emerging provider programs, rather than solely administering established network programs
• Balance innovation with operational feasibility, scalability, provider experience, regulatory requirements, and measurable business outcomes

Skills

Strategic leadership

Portfolio management

Regulatory compliance

Team leadership

Stakeholder communication

Education

Bachelor's degree

Job description

GuideWell, the Florida Blue company, seeks a Senior Manager of Network Business Operations & Program Mgmt to lead teams delivering strategic network initiatives, ensuring regulatory compliance, and driving operational excellence across multiple workstreams.

You will own portfolio management, supervise staff, coordinate with stakeholders, and oversee reporting, vendor interactions, and documentation development for enterprise-wide network programs.