Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

The Director of Provider Partnerships Strategy plays a critical leadership role within the Provider Partnerships organization. Working closely with the Senior Vice President of Provider Partnerships, the Vice President of Provider Partnerships Strategy, the Provider Partnerships leadership team and Line of Business stakeholders, the Director of Provider Partnerships Strategy leads provider network strategic initiatives and their tactical execution, ensuring alignment with the Lines of Business and the organization’s overall financial, operational, and clinical goals. The Director manages a team of colleagues supporting analytics and network consultancy aligned to the strategic focus of the team she/he is managing, such as Government or Commercial Products. Working in a matrix environment to support and collaborate with colleagues from System Contracting, Ancillary Contracting, Actuarial, Sales and Provider Performance, he/she oversees the development and timely delivery of relevant and meaningful analyses and presentations in support of Point32Health’s provider contracts and network performance.


In addition to the Lines of Business, this individual collaborates closely with Sales, Finance, Product, Medical Management, Government Relations, Marketing, IT, and other enterprise-level teams to assure business needs are effectively communicated, building consensus among vested parties that results in alignment and timely execution of the business deliverables.

Job Description

DUTIES/RESPONSIBILITIES – what you will be doing (top five):

• Design and implement processes to support effective Provider Partnerships overall governance, including developing and executing multi-year department strategy, continuous alignment with the various lines of business, operational capacity planning/mapping, and management of Key Performance Indicators (KPIs) for the department
• Support the coordination and execution of enterprise processes, including and not limited to the Monthly Operations Review (MOR), Run the Business (RTB), Affordability of Care and Total Cost of Care process improvement efforts, Finance reviews & reforecasting, Contract Executive Committee as well as the CMPO/CPC Annual Planning process and Board of Directors meetings
• Proactively identify and oversee the development of analyses, models, and tools to offer an informed view of provider, network, and contract performance
• In collaboration with System and Ancillary Contracting leadership, formulate and execute on strategies to improve unit cost, standardize reimbursement methodologies, and maintain competitive provider network
• Provide direction and define approach and parameters for overall reimbursement strategy and payment methodologies, with the goal of standardization, optimization, and transparency. Oversee development of provider rates in line with negotiated terms
• Oversee the submission of regulatory submissions and requests
• Monitor, analyze and report on competitive position for all applicable Point32Health markets
• Produce accurate and timely reporting on network access and adequacy, ensuring standards are maintained and gaps are appropriately addressed
• Provide on-going leadership and program/project management support for foundational and strategic initiatives
• Design communications for and support executive-level presentation by the SVP of Provider Partnerships
• Develop and execute business plans, project charters and work breakdown structures, specifying goals, strategy, governance, staffing, scheduling, identification of risks, contingency plans, and communication plans as necessary
• Recruit, train and develop talent; provide coaching feedback and direction to staff to support development and success

QUALIFICATIONS – what you need to perform the job

Certification and Licensure

• N/A

Education

• Required (minimum): Bachelor's degree in business, health administration, finance or a related field
• Preferred: Master's degree or relevant experience
• Certification or equivalent expertise in process improvement (any methodology; Lean Six Sigma preferred), change management (PROSCI), and project management (Waterfall and/or Agile)
• Extensive experience designing and implementing organizational strategies and/or strategic initiatives

Experience

• Required (minimum): 10-15 years of progressively responsible management experience in a complex healthcare setting
• Preferred: Previous experience in managed care contracting or healthcare consulting
• Previous people management experience
• Previous responsibilities requiring interactions with senior leaders, especially in a cross-functional environment

Skill Requirements

• Energetic, goal-oriented leader with a proven ability to deliver results and lead teams to achieve goals

• Strong collaborator able to work effectively across functions
• Exceptional oral and written communication skills, with a particular focus on presentations to and communications with senior leaders
• Excellent interpersonal skills and a high level of diplomacy to anticipate, recognize and deal effectively with complex issues
• Ability to manage and direct multiple priorities across markets while meeting aggressive deadlines
• Self-starter who is comfortable in evolving and/or ambiguous situations; able to maintain constructive behavior in challenging situations
• Strategic thinking skills with the ability to draw meaningful insights, identify business implications, and proactively anticipate potential obstacles or challenges
• Fast learner with a demonstrated ability to master new content quickly
• Excellent management skills to guide, inspire and develop a high performing team
• Expertise with the following software strongly preferred: Microsoft Office, MURAL or Miro, Adaptive Insights

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel):

• Must be able to work under normal office conditions and work from home as required
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations
• May be required to work additional hours beyond standard work schedule

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Salary Range

$160,097.60 -$240,146.40

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

• Medical, dental and vision coverage

• Retirement plans

• Paid time off

• Employer-paid life and disability insurance with additional buy-up coverage options

• Tuition program

• Well-being benefits

• Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

We welcome all
All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org