Sr Manager Network Business Ops & Program Management

About the Role

This position is accountable for leading one or more teams to achieve targeted outcomes and capabilities for key strategic initiatives in support of network development, network management, and network operations. The role ensures the implementation of sustainable and scalable programs to maintain best-in-class Network Management practices while upholding compliance with regulations from agencies such as CMS, AHCA, NCQA, and the Blue Cross Blue Shield Association (BCBSA).

Responsibilities

• 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.
  • 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.
• 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:
  • 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 an 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.

Requirements

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

Preferred Qualifications

• Master’s degree.
• In-depth knowledge of the health industry.
• Broad business experience spanning multiple business functions, preferably in the health industry.
• Strong problem-solving skills.
• Effective interpersonal skills with a demonstrated ability to develop and maintain strong business relationships.
• Ability to act in a consultative and influencer role across all levels of leadership, including executive leaders.

Physical Demands

• Exerting up to 10 pounds of force occasionally to move objects.
• Sedentary role with occasional traversing activities required.
• Occasional travel to multiple locations for work (e.g., meetings, events, conferences).

Benefits

• Comprehensive 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 and a comprehensive wellness program.

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

Pay

Typical annualized offer/hiring range: $109,300 - $136,600.

Annualized salary range: $109,300 - $177,600. Final pay will be determined based on market competitiveness, internal equity, and job-related knowledge, skills, training, and experience.

Opportunities for incentive or commission compensation and regular annual reviews with pay-for-performance considerations for base pay increases.