Manager Policy Management and Provider Strategy

The Manager of Policy Management & Provider Strategy is a strategic leader responsible for advancing quality outcomes and accurate payment through the development and execution of integrated policy and provider strategies. This role leads the governance, coordination, and communication of clinical and operational policies, ensuring alignment with enterprise goals, regulatory standards, and quality initiatives. As a key partner across the enterprise and with external stakeholders, this role plays a critical part in shaping and executing the Quality roadmap—driving strategic alignment between policy management, provider oversight, and payment quality. The manager also champions enterprise-wide education and awareness efforts to build understanding of policy intent, application, and impact.

• Leads initiatives and programs—both directly and through influence—focused on policy development, governance, quality-focused provider strategy, and education around payment quality management. Partners across all lines of business and collaborates with key departments including Sales, Claims, Dental Affairs, Actuarial, Provider Network Development, Utilization Management, and Grievance and Appeals to ensure alignment and execution.
• Leads a team and supports the collaborative drafting, publishing, communication, transparency and management of clinical and business policies.
• Directs the design and delivery of communication strategies, ensuring all communications build understanding of policy intent and quality expectations among internal teams and external partners.
• Oversees the strategic coordination and operational management of the Business Policy Decisioning Council, including intake, triage, meeting cadence, and communications. Partners with requestors to ensure proposals are well-prepared and aligned with business objectives prior to review.
• Leads the development and ongoing management of centralized policy resources that guide the administration of clinical and non-clinical policies, contractual obligations, and regulatory requirements. Ensures these resources drive quality outcomes, support accurate payment practices, and influence provider behavior in alignment with enterprise goals.
• Leads cross-functional collaboration to shape and evolve the quality provider strategy, driving prioritization and roadmap execution to strengthen provider partnerships and ensure accountability to the highest standards of quality care.
• Participates in annual strategy and planning sessions and contributes to the development of support materials to ensure there is a clear Quality roadmap and plan to monitor and improve quality outcomes, payment, and provider behavior.
• Oversees the cross-functional design, implementation, and ongoing administration of enterprise provider incentive programs.
• Manages and develops multi-disciplinary teams to achieve strategic objectives, encompassing determining staffing needs, setting goals, monitoring performance, interviewing, selecting, coaching, and evaluating the performance of all direct reports, and overseeing, and maintaining department budgets.

• 8+ years w/Bachelor's degree; 1+ years supervisory/management.
• Strong people leadership skillsets, including talent development and the ability to realize strategies through a team.
• High detail orientation with strong analytical, critical thinking and problem-solving skills.
• Excellent organizational/time management and project management skills.
• Extensive knowledge of health care industry.
• Excellent interpersonal, verbal, and written communication skills, including proven ability to collaborate and influence across all functions and levels of the organization.
• Proven ability to resolve conflict and facilitate decision-making.
• Ability to quickly extract key insights from complex data and details.
• Ability to translate an opportunity into an educational campaign, leveraging multiple mediums.

• Competitive base and incentive pay
• 401(k) with robust matching and non-matching contributions
• Rich medical & pharmacy benefits
• 100% employer-paid dental and vision benefits
• Holistic wellbeing program with deep financial incentives
• Generous paid time off plus 12 paid holidays and your birthday off
• Culture of growth and learning: career development; tuition reimbursement; recognition program
• Family support: adoption assistance, fertility treatment, child, elder & pet care assistance
• Social responsibility and volunteer opportunities
• Employee discount program