Job Code
G1226HF

Department Name
Health Fund Admin

Reports To
Assistant Director, Health Programs

FLSA Status
Exempt

Union Code
N/A

Management
Yes

Job Summary:

Under the direction of the Assistant Director, Health Programs, the Manager, Health Programs plays a key and collaborative role in the development, implementation, and continuous improvement of the Health Fund's clinical programs and provider partnerships.

The Manager, Health Programs is responsible for overseeing day-to-day program operations, managing strategic provider relationships, monitoring program performance and outcomes, and collaborating with internal and external stakeholders to support innovative health initiatives. This position serves as a key management role in advancing quality, affordability, operational effectiveness, and member satisfaction while supporting the Health Fund's broader strategic objectives.

Essential Duties and Responsibilities:

• Provide leadership and guidance to program professionals, Health Fund staff, and cross-functional stakeholders to support successful program execution, issue resolution, and continuous improvement

• Supervise staff and provide coaching, work direction, performance management, and professional development while monitoring day-to-day program operations and assigned functions

• Manage and strengthen strategic relationships with the Fund's current key clinical partners as well as future provider partnerships

• Serve as the primary operational liaison for assigned provider organizations, addressing escalated operational, provider, member, and claims-related issues

• Lead regular business and performance reviews with assigned providers and vendors, documenting decisions, action items, service-level issues, and remediation plans

• Serve as a subject matter expert on Health Fund benefits, clinical programs, provider reimbursement methodologies, claims administration processes, and plan design; provide guidance to internal stakeholders regarding operational impacts and member experience

• Maintain expertise in Health Fund medical benefits, plan design, clinical programs, provider reimbursement, and operational workflows

• Develop, monitor, and report on program performance metrics, quality outcomes, utilization trends, member satisfaction, and financial results and identify opportunities for continuous improvement and implement corrective actions

• Work with the Implementation Team on new clinical initiatives, coordinating timelines, testing, communications, operational readiness, and post-implementation monitoring

• Partner with Compliance, Engineering/IT, Analytics, Product, Communications, Eligibility, Member Services, and Health Services Teams to operationalize benefit changes, provider programs, and system enhancements

• Regularly monitor operational and claims trends to identify systemic issues and develop corrective action plans with internal teams and external partners

• Assist with development, maintenance, and implementation of Summary Plan Descriptions (SPDs), benefit communications, and operational policies related to assigned programs

• Assist Communications Team with member and provider education initiatives that improve utilization of high-value providers and clinical programs

• Prepare and maintain program documentation, dashboards, project plans, and executive status reports

• Develop business cases and recommendations for program expansion, redesign, or discontinuation based on clinical outcomes, member experience, operational feasibility, and financial performance

• Collaborate with Legal, Compliance, Finance, and Procurement to support provider contract negotiations, renewals, performance guarantees, regulatory compliance, and vendor governance activities

• Collaborate with the Assistant Director, Health Programs on strategic planning, program expansion, and continuous process improvement

• Serve as a designated backup to the Assistant Director, Health Programs, providing continuity of program operations, stakeholder coordination, and issue resolution.

• Perform other relevant duties and special projects as assigned by management and senior leadership

Qualifications (Competencies):

• 3+ years of progressively responsible experience in clinical program management, health plan operations, provider relations, healthcare administration, or health plan strategy

• Demonstrated ability to evaluate program performance, identify improvement opportunities, and develop recommendations that support organizational objectives

• Experience managing vendor, provider, hospital, or strategic partner relations, including performance reviews, issue resolution, and ongoing program oversight

• Experience managing provider or hospital relationships and cross-functional projects

• Strong knowledge of health insurance benefits, provider reimbursement, claims administration, and healthcare delivery systems

• Proven leadership experience supervising, mentoring, and developing staff while fostering a collaborative team environment.

• Demonstrated ability to lead multiple complex initiatives simultaneously and build collaborative relationships with internal and external stakeholders

• Strong experience using formal project management methodologies

• Excellent MS Office skills including Visio, PowerPoint and MS Project

• Demonstrated ability to create project plans, manage scope and schedule for portal/CRM and other projects preferred

• Ability to prioritize work and meet deadlines

• Ability to translate operational and utilization data into actionable recommendations that support program objectives

• Knowledge of applicable healthcare regulations and compliance requirements, including HIPAA and ERISA

Soft Skills (Interpersonal Skills):

• Excellent analytical, communication, presentation, organizational, and problem-solving skills

• Ability to influence stakeholders, build consensus, and collaborate effectively across departments and external organizations

• Demonstrated ability to exercise sound judgement, manage competing priorities, and adapt effectively in a fast-paced and evolving environment

• Strong leadership and collaboration skills

• Ability to establish and maintain effective working relationships with project team members, supervisors, and employees from other departments

• Ability to plan and take initiatives to accomplish objectives in timely fashion

Education:

Bachelor's degree in a related field (e.g. Public Health, Psychology, Health Administration) or combined work experience and education required.

Master's degree preferred.

Language Skills:

Reasoning Ability:

High

Certificates, Licenses, Registrations:

Shift

Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals to perform the essential functions.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals to perform the essential functions.

• Under 1/3 of the time: Standing, Walking, Climbing or Balancing, Stooping, Kneeling, Crouching, or Crawling
• Over 2/3 of the time: Talking or Hearing
• 100% of the time: Using Hands

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• 1/3 to 2/3 of the time: Work near moving or mechanical parts, exposure to radiation, moderate noise.