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About the Role
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. This position 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 role advances quality, affordability, operational effectiveness, and member satisfaction while supporting the Health Fund's broader strategic objectives.
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.
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.
Skills
- Excellent analytical skills
- Excellent communication skills
- Excellent presentation skills
- Excellent organizational skills
- Excellent problem-solving skills
- Ability to influence stakeholders
- Ability to build consensus
- Ability to collaborate effectively across departments and external organizations
- Demonstrated ability to exercise sound judgement
- Demonstrated ability to manage competing priorities
- Demonstrated ability to adapt effectively in a fast-paced and evolving environment
- Strong leadership skills
- Strong 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
Location
- N/A
Work Type
- N/A
Experience Level
- Management
Education Level
- 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.
About the Company
- Building Services 32BJ Benefit Funds (“the Funds”) is the umbrella organization responsible for administering Health, Pension, Retirement Savings, Training, and Legal Services benefits to over 185,000 SEIU 32BJ members.
- Our mission is to make significant contributions to the lives of our members by providing high quality benefits and services.
- Through our commitment, we embody five core values: Flexibility, Initiative, Respect, Sustainability, and Teamwork (FIRST).
- The Funds oversees and manages $11 billion of dollars in assets, which are made up of many, varied and complex funds.
- 32BJ Benefit Funds will continue to drive innovation, equity, and technology insights to further help the lives of our hard-working members and their families.
- We use cutting edge technology such as: M365, Dynamics 365 CRM, Dynamics 365 F&O, Azure, AWS, SQL, Snowflake, QlikView, and more.