Jobs at GuideWell

Provide senior consultative support for network business operations and program management, leading complex initiatives from design to implementation, advising leadership, developing processes and tools, using data to prioritize high-value efforts, managing stakeholders, communications, and occasionally supervising a small team.

Lead teams and manage a portfolio of network development, management, and operations programs. Ensure regulatory compliance (CMS, AHCA, NCQA, BCBSA), implement scalable processes, manage budgets (~$3.5M/project), coordinate cross-functional stakeholders, maintain provider/network documentation, and support sales RFI/RFP and reporting activities.

Lead enterprise consumer social strategy, governance, and platform portfolio across five brands. Build content architecture, publishing standards, and scalable response operations. Enable business units through cross-functional partnership, measurement linking social activity to business outcomes, and pilot emerging platforms. Manage a small team and oversee tools, compliance, and escalation protocols.

Lead cross-channel customer experience analysis by combining quantitative and qualitative signals (NPS/CSAT/CES, contact center, digital analytics, transactional and complaint data). Design and run deep-dive investigations, translate findings into operational recommendations, coach analysts, partner with channel owners, and maintain measurement and narrative standards to drive quarter-over-quarter operational change.

Lead enterprise customer segmentation and personalization analytics: design and run segmentations, interpret results, recommend activation strategies, partner with marketing and audience owners, track campaign performance, and coach analysts to maintain segmentation standards across the activation lifecycle.

Manage an actuarial team and produce actuarial analyses for pricing, reserves, trend analytics, gross margin and financial reporting across ACA, Medicare, and Group lines. Participate in rotational assignments, represent actuarial in cross-functional workgroups, and support pricing, reporting, and analytic initiatives.

Lead and mentor Scrum teams and Scrum Masters across high-complexity IT initiatives. Facilitate Agile ceremonies, remove impediments, drive continuous improvement, provide metrics to leadership, protect teams from distractions, and oversee delivery for cloud and AI-enabled enterprise transformations.

Lead GuideWell's executive thought leadership strategy and execution, owning leader LinkedIn, speaking pipeline, executive coaching, cross-functional integration, and measurement to advance enterprise narrative and reputation.

Senior leader responsible for enterprise acquisition marketing strategy and serving as CMX's strategic representative to the ACA segment. Leads acquisition planning, creative and communications, campaign operations, and local market/sales support. Mobilizes cross-functional CMX experts, oversees campaign execution across channels, ensures compliance, drives performance measurement and forecasting, and builds trusted relationships with segment leaders to align marketing to business growth targets.

Manage and grow relationships with mid-sized employer clients and distribution partners, ensure plan performance, lead cross-functional teams for implementations and renewals, drive retention and upsell, ensure compliance, and deliver exceptional client support and reporting.

Provide specialized corporate governance legal counsel to the Board and committees; prepare and manage Board materials; develop governance policies; advise on director qualifications, executive compensation, D&O matters, transactions, and compliance; coordinate with external stakeholders; manage governance records; conduct legal research and prepare opinions and memoranda.

Provide enterprise-wide legal counsel on federal and state healthcare regulatory matters. Monitor and interpret laws and enforcement activity, advise business units on compliance and regulatory strategy, develop policies, conduct regulatory risk assessments, coordinate with outside counsel, support compliance program implementation, respond to regulator inquiries, and prepare regulatory analyses for leadership and the Board.

Perform concurrent medical reviews using InterQual and benefit criteria to determine appropriate level of care, coordinate discharge planning, identify care programs, liaise with facility case managers and providers, and facilitate transitions to home-based services to reduce readmissions.

Lead enterprise AI governance, risk management, and Responsible AI adoption. Oversee AI inventory, policy, risk lifecycle, regulatory compliance, vendor assessments, and integration of governance into business workflows. Partner with Legal, Compliance, Security, PMO, and business units to prioritize AI initiatives, report metrics and ROI, and advise executives and boards.

Perform utilization management duties including pre-certification and concurrent review of admissions, medical record review for medical necessity, discharge planning, steering to in-network providers, evaluating cost-effectiveness of treatment plans, identifying alternative care plans, interpreting health plans, coordinating authorizations and referrals to care management resources.