Aimed at mid-to-senior level professionals in healthcare network operations who can lead cross-functional initiatives and balance innovation with regulatory compliance.
Derived from job-description analysis by Serendipath's career intelligence engine.
Original posting from GuideWell Mutual
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 goalsOwn 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 goalsRecruit, motivate, and assess staff performance; build high-performing teamsProvide 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 complianceEnsure Network Regulatory Compliance activities: quarterly/annual filings (CMS, NCQA, AHCA), certifications, product/network filings, NSA processes (IDR, COC), and audit coordinationEnsure Network Adequacy; coordinate with Network Management on gaps and remediation
Stakeholder Communication & Influence
Present network metrics, recommendations, and deliverables to executive leadership on transformational projectsCommunicate across internal and external audiences; influence stakeholder decisionsCoordinate 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 programsManage 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 programsExperienced identifying new approaches to provide engagement, collaboration, performance, or network management and translating concepts into scalable programs and operations solutionsStrong problem-solving skills, effective interpersonal skills with a demonstrated ability to develop and maintain strong and effective business relationshipsAbility to act in a strong consultative and influencer role across all levels of leadership, including executive leadersAbility to balance innovation with operational feasibility, scalability, provider experience, regulatory requirements, and measurable business outcomes.
What We Require
6+ years related work experience3+ 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 GuideWell’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 insuranceIncome protection benefits: life insurance, short- and long-term disability programsLeave programs to support personal circumstancesRetirement Savings Plan including employer matchPaid time off, volunteer time off, 10 holidays and 2 well-being daysAdditional 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.
Source: GuideWell Mutual careers