Manager, Health Programs

BLDG SVC 32 B-J•New York, NY

3d•$112,000 - $119,000

About The Position

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.

Requirements

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
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

Nice To Haves

Master’s degree preferred.

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