- Provide leadership and guidance to program professionals Health Fund staff and cross-functional stakeholders to support successful program execution issue resolution and continuous improvement
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- Supervise staff and provide coaching work direction performance management and professional development while monitoring day-to-day program operations and assigned functions
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- Manage and strengthen strategic relationships with the Funds current key clinical partners as well as future provider partnerships
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- Serve as the primary operational liaison for assigned provider organizations addressing escalated operational provider member and claims-related issues
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- Lead regular business and performance reviews with assigned providers and vendors documenting decisions action items service-level issues and remediation plans
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- 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
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- Maintain expertise in Health Fund medical benefits plan design clinical programs provider reimbursement and operational workflows
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- 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
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- Work with the Implementation Team on new clinical initiatives coordinating timelines testing communications operational readiness and post-implementation monitoring
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- Partner with Compliance Engineering/IT Analytics Product Communications Eligibility Member Services and Health Services Teams to operationalize benefit changes provider programs and system enhancements
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- Regularly monitor operational and claims trends to identify systemic issues and develop corrective action plans with internal teams and external partners
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- Assist with development maintenance and implementation of Summary Plan Descriptions (SPDs) benefit communications and operational policies related to assigned programs
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- Assist Communications Team with member and provider education initiatives that improve utilization of high-value providers and clinical programs
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- Prepare and maintain program documentation dashboards project plans and executive status reports
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- Develop business cases and recommendations for program expansion redesign or discontinuation based on clinical outcomes member experience operational feasibility and financial performance
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- Collaborate with Legal Compliance Finance and Procurement to support provider contract negotiations renewals performance guarantees regulatory compliance and vendor governance activities
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- Collaborate with the Assistant Director Health Programs on strategic planning program expansion and continuous process improvement
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- Serve as a designated backup to the Assistant Director Health Programs providing continuity of program operations stakeholder coordination and issue resolution.
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- Perform other relevant duties and special projects as assigned by management and senior leadership
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