Jobs in Cedar Crest Massachusetts
349 positions found — Page 3
Job Function:
* General and Movement disorders.
* Inpatient and Outpatient.
* Work out of two locations.
* M-F with limited call.
* Hospital based with large referring physicians.
Location: Brockton, MA
MPLT Healthcare is looking for physicians who Understand the Urgency, Never Give Up, and Have the Courage to Excel in the forever changing medical industry! We have numerous opportunities for an experienced OB Hospitalist with highly competitive pay rates in Brockton, MA.
Position Details:
* Board Certified/Board Eligible Required
* Active Massachusetts License Required
* ASAP Start
The benefits of working with MPLT Healthcare include:
* Flexibility - work when, where and how often you d like to work
* Paid malpractice insurance
* Pre-paid travel and housing expenses
* Competitive compensation paid on a weekly basis
* One-on-one attention and 24-hour access to your personal MPLT Healthcare consultant
* Dedicated medical staff services that assist with credentialing and facility paperwork
About MPLT Healthcare
MPLT Healthcare specializes in placing well-qualified physicians and advanced practice clinicians in locum, locum-to-perm and direct hire staff and leadership positions while making this process as seamless as possible for our clinicians and client facilities.
Don t delay, apply today!
OB/GYN Physician Near Boston
StartDate: ASAP Pay Rate: $322020.00 - $463535.00
A well-established hospital in south Boston is rapidly growing and adding OB/GYNS either for a general position or laborist. This position offers an incredible quality of life, high financial incentive, and the ability to live in a desirable location in Boston and the surrounding suburbs.
Opportunity Highlights:
* General
* 4-day work week combining clinic and office
* 50/50 Mix
* 2- Call Days per Month
* Laborist
* 7 Shifts Per Month
* 2-3 OBGYNs on service daily, plus CNM's
* Amazing Benefit Package
Community Information:
The Unlimited Amenities Offered in Boston and the Surrounding Communities Include:
* Historic neighborhoods, abundant parks, vibrant cultural life and unrivaled educational opportunities
* Immediate access to the ocean and numerous beaches-only 2 to 3 hours drive to top ski resorts in the Northeast
* Living accommodations range from loft-style condos in Boston to large homes in family-friendly communities and everything in between
* City of Champions: Bostons professional sports teams and venues are world renowned not to mention the plethora of NCAA sporting events that take place year round
Facility Location
Often referred to as the "City of Champions," due to its proclivity to turning out high quality professional boxers, Brockton is situated just 20 miles outside of Boston and offers residents the archetypal historical New England living experience. The city has over 25 sites, buildings and homes listed in the National Historic Places register, including Brockton City Hall, Campanelli Stadium, and Howard Block. With Boston mere minutes away, Brockton residents are able to enjoy the perks of the big city from the confines of a comparatively small town.
Job Benefits
About the Company
At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.
Obstetrician/Gynecologist, Obstetrics/Gynecology, Obstetrics, Gynecology, Obgyn, Ob/Gyn, Pregnancy, Newborn, Maternity, Physician, Healthcare, Health Care, Patient Care, Hospital, Medical, Doctor, Md
- $575000.00 Diagnostic Radiologist Suburban Boston Competitive Compensation + Work-Life Balance $525K$575K Low Volume that offers Incredible Work-Life Balance Location: Brockton, MA (Greater Boston Area) Schedule: MondayFriday 8AM-5PM Weekend Call Required (post call days off given) Salary: $525,000 $575,000 Sign-On Bonus & Relocation Assistance: $35,000 Why This Opportunity Stands Out -General Diagnostic Radiology with access to light IR procedures (can be up to 20%-30% of your practice)
- Reasonable Daily Volumes: Around 100 cases daily (40%-50% plain films) some Fluoro -Everything over (40) hrs per week paid at an additional $400 per hr.
per diem.
-Occurrence-Based Malpractice Insurance No tail coverage required -Ample Time Off Includes Paid CME -Full Support Staff Experienced technologists & clinical team Qualifications Board Certified/Eligible in Diagnostic Radiology Eligible for Massachusetts medical license Strong communication & collaboration skills Why Live in Brockton, MA? Just 25 miles south of Boston , Brockton offers the perfect blend of suburban comfort and urban access .
Affordable Living Median home prices around $450K Easy Commute Two MBTA stations with direct trains to Boston Green Spaces Enjoy D.W.
Field Park , trails, and golf Cultural Gems Fuller Craft Museum, local arts, and music Great Schools Family-friendly neighborhoods Love Boston? Youre Close Enough to Enjoy It All Top Universities Harvard, MIT, BU, Northeastern World-Class Hospitals MGH, Brigham and Womens Booming Job Market Healthcare, biotech, tech, and finance ? Diverse Neighborhoods From Beacon Hill to Dorchester Culture & History Museums, theaters, sports, and more Ready to take the next step in your career? Apply now or reach out for a confidential conversation .
Facility Location Often referred to as the "City of Champions," due to its proclivity to turning out high quality professional boxers, Brockton is situated just 20 miles outside of Boston and offers residents the archetypal historical New England living experience.
The city has over 25 sites, buildings and homes listed in the National Historic Places register, including Brockton City Hall, Campanelli Stadium, and Howard Block.
With Boston mere minutes away, Brockton residents are able to enjoy the perks of the big city from the confines of a comparatively small town.
Job Benefits About the Company At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.
Radiologist, Diagnostic Radiologist, Emergency Radiology, Interventional Radiology, Diagnostic Medical Physicists, radiology radiology, radiologist
- Brockton Salary Range : 0.00
- 0.00 per year (USD Permanent) Job Type : Permanent Recruiter Email : Community health center south of Boston serving a diverse population is seeking primary care physicians for its Patient Centered Medical Home Model.
Physicians will have assigned patient panels that are capped at 1500 patients.
Located in beautiful new building with floors that include Urgent Care, Adult Medicine, OB/GYN, Pediatrics, Behavioral Health, Optometry and Dental Services.
Physicians must be Board Certified of Board Eligible in Internal Medicine or Family Medicine.
Starting salary of $200,000 Earn up to $10,000/year in incentive bonuses Opportunity to increase base salary upon completion of incentive goals Generous loan repayment offered for a 2 year commitment Relocation up to $10,000 offered Legal fees of up to $5,000 offered for physicians with visa issues Full comprehensive benefits and malpractice offered CME provided Paid Time Off up to 34 days per year Physicians will see patients 8:15-5:30 four days per week, 11-8 once a week and one Saturday every 8 weeks Using NextGen's EM Call is 1 in 8 and is telephone coverage only Visa Candidates are welcome Excellent location just 40 miles south of Boston, 20 minutes to Providence, RI and less than an hour to Cape Cod.
- Brockton Salary Range : 0.00
- 0.00 per hour (USD Permanent) Job Type : Permanent Recruiter Email : Community health center south of Boston serving a diverse population is seeking primary care physicians for its Patient Centered Medical Home Model.
Physicians will have assigned patient panels that are capped at 1500 patients.
Located in beautiful new building with floors that include Urgent Care, Adult Medicine, OB/GYN, Pediatrics, Behavioral Health, Optometry and Dental Services.
Physicians must be Board Certified of Board Eligible in Internal Medicine or Family Medicine.
Excellent starting salary Full comprehensive benefits offered Generous loan repayment available CME provided Paid Time Off up to 34 days per year Physicians will see patients 3 days per week including one evening per week Using NextGen?'s EM Hospital call group in approximately 8-10 physicians Visa Candidates are welcomeExcellent location just 40 miles south of Boston, 20 minutes to Providence, RI and less than an hour to Cape Cod.
This respected multispecialty practice has 100+ dedicated providers serving patients in six Boston suburbs.Practice in a modern, conveniently-situated medical arts complex where collaborative practitioners offer outpatient primary care (all ages), behavioral health, specialty care including cardiology, endocrinology and pulmonology, urgent care and more with onsite radiology and lab.
Step into an established, reputable operation and assume existing patients immediately.
Become part of a friendly team of five physicians and an NP in an organization that prides itself on respect, trust, transparency, and positive long-term patient relationships.
During the pandemic, patients are being seen in person and via telemedicine.You will have a convenient 4 day/week schedule with built-in admin time, and superb clinical and administrative support so you can focus on providing compassionate care in a state-of-the-art setting.
Phone-only call is shared across a large pool of providers, so your turn only comes up a few times each year.
This practice utilizes an award-winning EMR system, with in-house training provided.We are offering:EXCELLENT LOCATION between Boston and ProvidenceRespected physician-owned multi-specialty practiceState-of-the-art facilities and friendly, welcoming teamInteresting outpatient-only primary care practiceConvenient 4 day/week scheduleCompetitive salary plus productivity bonuses!Option to become a shareholder without a buy-in!Paid relocation assistancePaid liability insurance, health, dental and life insurance6 weeks of paid time off!Budget for your CME expensesEaston is a historic town of 25,000 between Boston and Providence RI and 15 miles east of Foxboro, home of the New England Patriots.
This is an area of desirable suburbs with safe, welcoming neighborhoods, excellent public schools, and numerous amenities catering to locals and visiting sports fans.
Massachusetts offers four distinct seasons, with blazing photogenic autumns, snowy action-packed winters, colorful springs and warm summers full of activity appealing to singles, families and retirees alike.Enjoy easy access to a wide range of superb restaurants, great shopping, live entertainment and more.
Boston offers many venues for socializing, sports and culture.
Visit famous sites of early American history, and sample some of the exceptional eateries for the freshest seafood, or fine international cuisine.
Or, head to Cape Cod for relaxing getaways, sailing or fishing, golf or antiquing.
Providence is 30 miles from Easton.
Rhode Islands capital offers a thriving arts community and a wealth of educational resources via several first-rate universities.
Or, check out the sparkly casinos of neighboring Connecticut, also in easy reach.This group is ready to hire please contact us for more information today!
- Brockton Salary Range : 0.00
- 0.00 per year (USD Permanent) Job Type : Permanent Recruiter Email : Community health center south of Boston serving a diverse population is seeking primary care physicians for its Patient Centered Medical Home Model.
Physicians will have assigned patient panels that are capped at 1500 patients.
Located in beautiful new building with floors that include Urgent Care, Adult Medicine, OB/GYN, Pediatrics, Behavioral Health, Optometry and Dental Services.
Physicians must be Board Certified of Board Eligible in Internal Medicine or Family Medicine.
Starting salary of $200,000 Earn up to $10,000/year in incentive bonuses Opportunity to increase base salary upon completion of incentive goals Generous loan repayment offered for a 2 year commitment Relocation up to $10,000 offered Legal fees of up to $5,000 offered for physicians with visa issues Full comprehensive benefits and malpractice offered CME provided Paid Time Off up to 34 days per year Physicians will see patients 8:15-5:30 four days per week, 11-8 once a week and one Saturday every 8 weeks Using NextGen?'s EM Call is 1 in 8 and is telephone coverage only Visa Candidates are welcome Excellent location just 40 miles south of Boston, 20 minutes to Providence, RI and less than an hour to Cape Cod.
- East Bridgewater Salary Range : 0.00
- 0.00 per year (Permanent) Job Type : Permanent Recruiter Email : Fully integrated healthcare community, south of Boston, is seeking Board Certified Internal Medicine and Family Medicine Physicians for practices south of Boston.
Group provides primary care, urgent care and specialty services to patients of all ages.
In business for more than 20 years and extremely well respected and thriving, the group is physician owned.
Position consists of full time hours in locations which are conveniently situated between Boston, Providence and Cape Cod.
Group has fully integrated EMR.
There is growth available within the group including shareholder opportunities with waived buy-in costs to incentivize physicians to join the organization.
Well respected and quickly growing, this organization offers a very competitive base salary, along with Medical, Dental, 401k with company match, generous paid time off, and more!
This is a very busy office with an excellent referral service and a billing service in place.
Compensation package is negotiable; benefits are available.
Flexible work schedule.
40 minutes from Cape Cod, hour to Providence, and hour to Boston.
Nestled quietly between Boston and Cape Cod, this city offers a multitude of entertainment destinations close by.
With commuter rail systems and major highways available, you are only minutes from whatever you desire.
How to Apply If you are interested and would like more information, please contact David Kerr at x243 or email us at regarding job number MA522
- Braintree Salary Range : 0.00
- 0.00 per year (USD Permanent) Job Type : Permanent Recruiter Email : Family Practice or Emergency Medicine physician needed for leadership in this thriving urgent care center.
Patient base is composed of all ages, with rare visits from children under two years old.
Patient care is first and foremost within this organization.
Ample Mid-Level support.
This clinic is a mix of urgent care consisting of non-life threatening illnesses and injuries as well as occupational medicine including pre-employment physicals, DOT physicals, work comp and more.Other benefits include: No call schedule MD support from advanced practitioners Paperless office On-site CLIA-approved lab Fully integrated EMR On-site digital X-rayLocated just south of Boston, the facility is centrally situated close to the highway, an international airport, and plenty of recreation.
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 Senior Contract Manager, Ancillary Network Contracting, will be part of the Point32Health Ancillary Network Contracting team reporting to the Manager, Ancillary Network Contracting. Senior Contract Manager will operate with minimal oversite to manage ancillary specialties, for Harvard Pilgrim and Tufts Health networks for all lines of business. The Senior Contract Manager is responsible for provider specialties that are more complex in reimbursement, benefit application, and/or larger networks.The Senior Contract Manager will function as point person for provider recruitments; determining network needs and evaluating prospective providers. The Senior Contract Manager will be responsible for working on contract negotiation and administration; adhering to plan reimbursement strategies. This individual will ensure that contract terms are consistent with the organization's established legal and financial guidelines. Additionally, the Senior Contract Manager will serve as a mentor; acting as a resource and assisting with training other team members. The Sr. Contract Manager will participate and will contribute to cross-divisional projects to ensure compliance and will collaborate on operational improvements and consistencies both internally and externally.
Job Description
- Develops, negotiates, executes and manages provider contracts for services and reimbursement issues with ancillary providers. Participates in all operational aspects of contractual agreements. Develops and maintains key provider relationships.
- Effectively manages the enterprise contractual structure with providers across networks and lines of business. As well as represent the ancillary providers within the organization to include key network issues relevant to plan strategy and operations.
- Collaborates with analytic staff to develop medical budget, evaluate cost trends, and formulate reimbursement models and/or program design. Monitors marketplace trends and new reimbursement methodologies. Is well versed in publicly reported data on reimbursement, market competitors, and regulatory requirements.
- Evaluates the demand for assigned services and identifies areas of network deficiencies or increased service demand for network expansion. Determines the unique service capabilities of providers in the network. Designs and implements tools for communicating these capabilities to other departments and membership.
- Identifies, evaluates, and implements new programs for improving medical cost management and/or administrative efficiency.
- Represents Ancillary Network Contracting team in internal and external meetings. Prepares and delivers presentations with providers and to partner departments.
- Maintains industry-specific knowledge and relationships with key providers and industry groups,
- Other duties and projects as assigned.
Salary Range
$103,034.92 -$154,552.38Compensation & 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 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
PDN-a1437186-23b8-4042-80f4-d2449e29ed6aWho 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
Under the supervision of the Utilization Management Supervisor, the Behavioral Health (BH) Utilization Management (UM) Clinician is responsible for conducting benefit coverage reviews and utilization management according to applicable regulatory guidelines and Enterprise contract requirements. The BH UM Clinician works collaboratively with the Behavioral Health leadership within the Behavioral Health department and other appropriate Point32Health staff to identify and address opportunities to improve service, reduce administrative cost, ensure clinically appropriate delivery of benefit covered services, and support department and organizational business goals. The UM BH Clinician escalates urgent issues and concerns that could potentially impact member needs, program compliance and or acute situations that pose risk. The UM BH Clinician must be committed to clinical and service excellence, including demonstrating the behaviors that support teamwork, collaboration, and professionalism. The BH UM clinician works under the direction of the UM Supervisor and in collaboration with the BH Operation Manager to ensure ongoing competency and learning needs are met that they are performing to applicable regulatory and clinical requirements.Job Description
Key Responsibilities/Duties - what you will be doing (top five):
- Adherence to established behavioral and administrative review guidelines and criteria
- Adherence to timelines, standards, and elements associated with organizational determinations and notifications
- Daily interactions with UM Support staff and providers to ensure clinical information and support are available and applicable to the review process
- Appropriate prioritization of authorization requests
- Achievement of expected productivity goals
- Review of all assigned prior authorization requests including but not limited to inpatient admissions, specialty referrals, outpatient procedures, VNA or outpatient therapies as specified in the prior authorization list using specified clinical criteria sets.
- Concurrent review of Behavior Health Services
- Identification and determination of benefit coverage for behavioral health coverage requests.
- Identifies and determines medical necessity of out of network requests for services.
- Effective communication with the Medical Director, regarding identified variances for specific members according to criteria utilized for medical review.
- Professional growth and development through self-directed learning activities and/or involvement in professional, civic, and community organizations
- Ongoing referrals to and interactions with the case management team to ensure efficient and safe care transitions and member access to supportive programs and services
- Works collaboratively with external providers to facilitate member access to high quality cost effective behavioral health services
- Adheres to all regulatory and contractual requirements
- Participates in department projects and special assignments as needed.
- Attends scheduled meetings, training session in both classroom and computer-based required training sessions. Assist in development and updating of department workflows.
- Other projects and duties as assigned.
Qualifications - what you need to perform the job
Certification and Licensure
- Current unrestricted Massachusetts license in a behavioral health area of practice
Education
- Required (minimum): BS Nursing; LICSW, LMHC, or other behavioral health profession qualified to practice independently.
- Preferred:
Experience (minimum years required):
- Required (minimum): Direct practice clinical experience in area of credential. Must demonstrate sound knowledge of utilization management and care management principles. Health Plan experience performing utilization review activities. Experience with McKesson's InterQual Clinical Screening Criteria.
- Preferred: 3 years in a managed care environment in managed care systems and operations.
Skill Requirements
- Ability to work cooperatively as a team member across multiple levels within the organization
- Results orientation - strives to meet business goals
- Critical and Analytic thinking, i.e., must understand cause and effect as it relates to workflow design and implications to policies, procedures, and other departmental functions
- Comfort adapting to changes to business, market, regulatory, and strategic needs
- Ability to influence others and serve as role model
- Strong communications skills (formal and informal, written and verbal
- Ability to handle multiple demands--must be able to balance multiple priorities
- Regard for confidential data and adherence to corporate compliance policy
- Proficiency with or ability to learn technology for initiating and participating in web/system-based communications: webinar, instant messaging, thin client, soft phone, or others
- Proficiency with or ability to learn technology-based programs such as Microsoft Office Word and Excel; other programs as needed
Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):
- Fast paced office environment handling multiple demands.
- Must be able to exercise appropriate judgment when necessary and work and communicate with customers in a telephonic office environment
- 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.
Disclaimer
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
$81,217.85 -$121,826.77Compensation & 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 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
PDN-a1375fa0-a517-4950-aefd-88a7808245faWho 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
Responsible for protecting the combined Harvard Pilgrim Health Care and Tufts Health Plan organization's legal interest for Point32Health and maintaining its operations within the scope established by law. Provides advice and support to the management and staff of the combined organization and its affiliates within assigned business areas. Responsible for representing the organization in legal disputes and litigation, identifying and analyzing legal issues, presenting clear recommendations, drafting key documents, and directly managing legal aspects of complex corporate initiatives.Job Description
Key Responsibilities/Duties - what you will be doing (top five):
- Represents corporate client in litigation and pre-litigation claims, administrative hearings and arbitration; works with outside counsel, as appropriate.
- Negotiates and drafts contracts, including leases, provider agreements, employer group agreements, confidentiality and business associate agreements, vendor agreements, computer hardware purchases and leases, software licenses and other agreements relating to operations.
- Provides legal services in connection with regulatory examinations and investigations, regulatory implementations, regulatory filings, and new product development; establishes and maintains direct relationships with state and federal regulatory authorities.
- Performs legal research and provides verbal and/or written legal advice to management and staff in various departments across the combined organization.
- Provides education to staff on legal issues, including risk management, confidentiality, and member rights.
- Perform other duties and projects as assigned.
Qualifications - what you need to perform the job
Certification and Licensure
- License to practice law in Massachusetts.
Education
- Required (minimum): Juris Doctor (J.D.) degree from an accredited law school.
- Preferred:
Experience
- Required (minimum): 5 years relevant legal and civil litigation experience in a law firm or in-house environment
- Preferred: 3 years health or insurance law experience
Skill Requirements
- Excellent verbal and written communication and advocacy skills.
- Excellent document drafting and negotiation skills.
- Excellent research skills with strong analytic ability to interpret contracts, legislation, laws, and regulations, identify issues and develop innovative solutions and strategies to reach satisfactory resolution.
- Mature judgment on relevant matters of business and law.
- Proactive - actively identify legal issues and time manage the legal aspects of projects.
- Ability to see the "big picture" as well as pay close attention to detail.
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.
- May be required to attend meetings at other company locations or other external meetings.
- 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.
Disclaimer
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
$149,798.10 -$224,697.14Compensation & 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 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
PDN-a0a88b63-0a65-45e2-a5cb-dbfaf1865913Who 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 Actuarial Analyst I support the analysis and data needs for a broad range of financial and actuarial functions. This support will include rate reviews, financial planning and projections, trend analysis, product development, provider reimbursement analysis, fee schedule development, provider risk analysis, and medical cost containment analysis. This role will work closely with a variety of departments including underwriting, sales, contracting, and medical management.Familiarity with the health insurance industry as well as experience in relational databases, data warehouses, Excel and statistical modeling as well as strong interpersonal skills are required. The position is eligible to participate in the Actuarial Student Program, including job rotations every 18-36 months and comprehensive support of the pursuit of Fellowship in the Society of Actuaries.Job Description
Key Responsibilities/Duties - what you will be doing (top five):
- Planning, Design, Project/Process Management
- Performs analytic project work assigned by manager
- Provides input into analytic project plan development
- Technical Analysis
- Uses data systems and query tools to complete work projects, primarily by modifying existing code and tools
- Checking/Validation/Peer Review
- Performs basic checks for data consistency, according to defined criteria
- Analysis/Interpretation
- Examines and interprets results in the context of the specific business questions being addressed
- Communication/Presentation of Results
- Packages results to demonstrate how the analysis answers identified questions
- Other projects and duties as assigned.
Qualifications - what you need to perform the job
Education, Certification and Licensure
- College degree required.
- Completion of 1-3 actuarial exams
Experience (minimum years required):
- 1 - 3 years' demonstrated experience in analytic work
- Experience in the use of personal computers, relational databases, statistical packages, spreadsheet and/or database applications
Skill Requirements
- Well-developed verbal and written skills
- Able to operate in a matrix environment
- Able to follow Actuarial department standards and processes
- Receives regular management oversight of all tasks, projects and processes
- Applies own judgment to limited analytical/technical issues
- Must be able to work cooperatively as a team member.
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.
Disclaimer
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
$63,713.72 -$95,570.58Compensation & 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 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
PDN-a0fd0928-e742-4243-a28e-7cef85f11f9fWho 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 Care Manager - Nursing Field (RN CM) will ensure that all members receive timely care management (CM) across the continuum, including transitions of care, care coordination and navigation, complex case management, population health and wellness interventions, and disease/chronic condition management per department guidelines. The nurse care manager possesses strong clinical knowledge, critical thinking skills, and ability to facilitate a care plan which ensures quality medical care for the member. The RN CM works closely with the member, the caregiver/authorized representative, and providers to meet the targeted member-specific goals. Based on national standards for CM practice, the RN CM focuses on empowering the member to support optimal wellness and improved self-management.Job Description
Key Responsibilities/Duties - what you will be doing
- Perform telephonic member outreach and/or face-to-face encounter utilizing key motivational interviewing skills to facilitate program enrollment. Perform departmental assessments and evaluate member holistically to identify needs, health goals, and barriers to wellness. Through assessment and collaboration with member/caregiver and providers, develop a member-specific plan of care, implement member-specific care manager interventions, and revise plan of care as needed. Complete documentation in applicable platform according to departmental policy and regulatory standards.
- Provide targeted health education, proactive strategies for condition management, and communication with key providers and vendors actively involved in the member's care.
- Collaborate with member/caregiver and the facility care team to coordinate a safe transition to the next level of care, which includes but is not limited to ensure understanding post-hospital discharge instructions, facilitate needed services and follow-up, and implement strategies to prevent re-admission.
- Collaborates and liaises with the interdisciplinary care team, to improve member outcomes (i.e., Utilization Management, Medical Director, pharmacy, community health workers, dementia care specialists, wellness, and Behavioral Health CM). Attending and presenting (as appropriate) high risk members at interdisciplinary rounds forum.
- Maintain professional growth and development through self-directed learning activities.
Qualifications - what you need to perform the job
Certification and Licensure
- Registered Nurse with current unrestricted license in state of residence
- May be required to obtain other state licensure in states where Point32Health operates
- Understand and follow the provisions of state-specific Nurse Practice Act(s) where Point32Health operates
- National certification in Case Management desirable
Education
- Required (minimum): Bachelor's degree or relevant equivalent experience
- Preferred: Bachelor's degree in nursing
Experience
- Required (minimum): 5 years' relevant clinical experience
- Preferred: Experience in home care or case management.
- Proficiency in a second language desirable.
- Experience in specialty areas a plus.
Skill Requirements
- Skill and proficiency in Microsoft applications, technical concepts and principles; computer software applications
- Work cooperatively as a team member across multiple levels within the organization
- Skilled in assessment, planning, and managing member care
- Advanced communication and interpersonal skills
- Independent and autonomous with key job functions
- Ability to address multiple complex issues
- Flexibility and adaptability to changing healthcare environment
- Ability to organize and prioritize work and member needs
- Demonstration of strong clinical and critical thinking skills
- Regard for confidential data and adherence to corporate compliance policy
Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):
- Must be able to work under normal office conditions and work from remote office as required.
- Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
- Ability to make face to face visits (member home, provider practices, facilities) as needed to meet the member needs and produce positive outcomes
- Valid Driver's license and vehicle in good working condition as travel is required
- May be required to work additional hours beyond standard work schedule.
- Other duties as assigned and needed by the department
COVID Policy
Please note: We encourage all Point32Health colleagues to follow CDC guidance about COVID-19 vaccines, boosters, isolation, and masking. Point32Health reserves the right to adjust its requirements in response to COVID-19 trends in the communities we serve.
Disclaimer
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
$87,137.85 -$130,706.77Compensation & 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 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
PDN-a1477787-b8eb-4d2c-9016-f0c67ef05a38Who 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, Inpatient Utilization Management is responsible for directing, leading, and modifying the business processes and operations for utilization management (UM) review tor is responsible for ensuring achievement of Point32Health corporate goals; compliance with Point32Health business rules; oversight of all aspects of outpatient services utilization management; and development, implementation and refinement of effective business processes that support compliance with relevant regulatory requirements (such as CMS, DOI, NCQA, ACA, USFHP and/or ASO/ERISA).The Director is expected to strategically develop and effectively deploy solutions in support of corporate and division specific goals. She/he will do so in an engaged and professional manner within and through a matrixed business environment. The Director will collaborate with division and enterprise business and medical leadership to drive clinical and/or operational initiatives. The Director is expected to collaborate with other Health Care Services peers / leaders, Operations and/or divisional department clinical leaders (such as the divisional CMO, Medical Directors, Directors and/or business leads), plan medical staff and key provider - facility and physician or group - clinical leadership.
The Director oversees and leads medical management activities related to utilization management and discharge planning for acute inpatient, LTAC (Long-term Acute Care) rehabilitation and skilled nursing services. The Director ensures initiatives are on schedule and within budget, and guides strategy, policies, and protocols in accordance with organizational strategy. The Director will ensure collaboration and coordination with enterprise or divisional based behavioral health and / or case management leaders and programs. The Director assumes a leadership role with internal and external customers to achieve optimal clinical and resource outcomes.
Job Description
Key Responsibilities/Duties
oversee and lead the precertification management and related authorization management operations for Commercial, Senior and Public Plans (MassHealth and QHP (Qualified Health Plan)) products.
- Effectively collaborates with divisional Chief Medical Officers, enterprise Medical Directors, enterprise, and division based Behavioral Health leaders to support appropriate utilization of health care services and quality of care for all products.
- Lead or support medical trend management initiatives in partnership with senior leaders for Health Care Services, Commercial and Government Market divisions.
- Develop, implement, and oversee business processes to ensure compliance with all federal and state regulatory and accreditation requirements and Point32Health business rules.
- Ensure that appropriate key performance and outcomes measures are in place, monitored and utilized for program assessment and program management.
- Oversee and lead effective relationships development between Point32Health and the facility / provider community.
- Actively participate in and/or lead workgroups and steering committees to identify, plan and implement Point32Health strategic expansion initiatives, utilization management, and/or clinical operations strategies.
- Represent Point32Health and Health Care Services to internal and external clients regarding clinical operations, utilization management, complex or unique client systems being designed or revised, and program performance for client specific SLAs (service level agreements) / KPIs (key performance indicators).
- Recruit, hire, educate, and evaluate staff.
- Guide and enhance the professional development of reporting staff. Provide coaching, feedback, and direction to ensure the successful achievement of business and professional goals. Support effective operational techniques while promoting customer satisfaction and operational efficiency in all areas of accountability.
- Plan budget and oversee management of department resources.
- Participate as a key member in the Utilization Management Team. Represents Health Care Services in relevant corporate teams.
- Other projects and duties as assigned.
Qualifications - what you need to perform the job
Certification and Licensure
RN (Registered Nurse) with unrestricted MA license preferred
Certification in Utilization Management is beneficial but not required
Education
- Required (minimum): Bachelor's degree
- Preferred: BSN (Bachelor of Science in Nursing); Master's degree
- Required (minimum): 10+ years of progressive and responsible operations experience in managed care and/or health plan systems, at least four (4) of which are at management level. Experience with operations of commercial (fully funded and self-funded), exchange, Medicaid and Medicare products required. Experience in managed care systems required. Ideal candidate will have extensive, relevant inpatient and/or medical management experience with a strong operational background.
Skill Requirements
- Must have a proven ability to achieve goals and deliver "bottom line" results.
- Excellent working knowledge of managed care operations and business processes is essential, with key expertise in the areas of inpatient management and proven competence in directing operational compliance with CMS regulatory and NCQA, URAC (Utilization Review Accreditation Commission) or DOI (Division of Insurance) requirements.
- Proven ability to successfully lead staff is required.
- Work cooperatively as a team member across multiple levels within the organization.
- Results orientation - drives to meet business-driven goals.
- Ability to handle multiple demands-must be able to balance multiple competing initiatives/interests.
- Requires the ability to think and plan strategically.
- Systems thinking - must understand overall Point32Health systems/people and the internal and external impact of business changes.
- Influencing others - particularly those outside of direct reporting relationships
- Strong communications skills (formal and informal, written and verbal)
- Coaching and Mentoring - primarily of direct reports, but also of others
The ideal candidate will be a high energy personality type who can mobilize a staff around a goal or set of goals and achieve it; is able to sustain high levels of activity over long hours when necessary and has the mental energy to constantly seek better alternatives. Requires focus on process engineering and improvement; discern larger patterns and relationships from smaller components and develop and implement work plans through application.
Frequent contact with senior leadership, physicians, managers, and peers necessitates excellent interpersonal and communication skills. A high level of diplomacy is necessary to anticipate, recognize, and deal effectively with politically sensitive issues. Excellent leadership skills are needed to guide and inspire others; encourage high standards and exemplify those standards; command attention and respect. Role requires change management and team engagement skills, including the ability to build coalitions across disciplines and departments throughout the company.
Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):
- Valid drivers' license and ability to provide transportation.
- 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
$166,666.40 -$249,999.60Compensation & 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 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
PDN-a1497a6d-2bb2-44ef-b65d-4ace6668d37fWho 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
Under the direction of the Pharmacy Utilization Management (UM) Supervisor, the Clinical Pharmacist is responsible for reviewing, processing and managing the daily caseload of pharmacy prior authorization (PA) requests for coverage determinations (CD), and exceptions. The Clinical Pharmacist ensures timely disposition of reviews for CD and exceptions by adherence to established timeframes. The Clinical Pharmacist consults as required with THP Medical Directors (MD) on prior authorization that fails to meet drug prior authorization (PA) criteria for coverage.Job Description
- Performs case reviews in automated prior authorization (Auto PA) tools and guides the case through the entire process to either approval or denial to ensure all coverage determinations and notices are consistent with applicable regulatory and accreditation requirements and turnaround times
- Provides all aspects of clinical support needed to perform drug prior authorization (PA) requests and consults as required with THP Medical Directors (MD) on cases that fail to meet coverage criteria
- Communicates daily with members, providers and other external customers regarding status and disposition of cases
- Oversees and addresses any quality issues with pharmacy technicians and confer with other clinical pharmacist on review questions
- Communicate with UM staff and providers when issues arise regarding policy interpretation, potential access availability or other quality assurance issues to ensure that members receive coverage determinations within timelines developed by all accrediting and regulatory guidelines
- Facilitates communication between Pharmacy UM department and other internal Tufts Health Plan departments by acting as a liaison or committee member on the development or implementation of new programs
- Performs other roles/duties and projects as assigned by the Pharmacy UM Supervisor or Manager
Salary Range
$107,379.06 -$161,068.58Compensation & 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 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
PDN-a0a2826d-4456-4bc7-9286-19b2dfa78c85Who 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 Care Manager - Nursing Field (RN CM) will ensure that all members receive timely care management (CM) across the continuum, including transitions of care, care coordination and navigation, complex case management, population health and wellness interventions, and disease/chronic condition management per department guidelines. The nurse care manager possesses strong clinical knowledge, critical thinking skills, and ability to facilitate a care plan which ensures quality medical care for the member. The RN CM works closely with the member, the caregiver/authorized representative, and providers to meet the targeted member-specific goals. Based on national standards for CM practice, the RN CM focuses on empowering the member to support optimal wellness and improved self-management.Job Description
Key Responsibilities/Duties - what you will be doing
- Perform telephonic member outreach and/or face-to-face encounter utilizing key motivational interviewing skills to facilitate program enrollment. Perform departmental assessments and evaluate member holistically to identify needs, health goals, and barriers to wellness. Through assessment and collaboration with member/caregiver and providers, develop a member-specific plan of care, implement member-specific care manager interventions, and revise plan of care as needed. Complete documentation in applicable platform according to departmental policy and regulatory standards.
- Provide targeted health education, proactive strategies for condition management, and communication with key providers and vendors actively involved in the member's care.
- Collaborate with member/caregiver and the facility care team to coordinate a safe transition to the next level of care, which includes but is not limited to ensure understanding post-hospital discharge instructions, facilitate needed services and follow-up, and implement strategies to prevent re-admission.
- Collaborates and liaises with the interdisciplinary care team, to improve member outcomes (i.e., Utilization Management, Medical Director, pharmacy, community health workers, dementia care specialists, wellness, and Behavioral Health CM). Attending and presenting (as appropriate) high risk members at interdisciplinary rounds forum.
- Maintain professional growth and development through self-directed learning activities.
Qualifications - what you need to perform the job
Certification and Licensure
- Registered Nurse with current unrestricted license in state of residence
- May be required to obtain other state licensure in states where Point32Health operates
- Understand and follow the provisions of state-specific Nurse Practice Act(s) where Point32Health operates
- National certification in Case Management desirable
Education
- Required (minimum): Bachelor's degree or relevant equivalent experience
- Preferred: Bachelor's degree in nursing
Experience
- Required (minimum): 5 years' relevant clinical experience
- Preferred: Experience in home care or case management.
- Proficiency in a second language desirable.
- Experience in specialty areas a plus.
Skill Requirements
- Skill and proficiency in Microsoft applications, technical concepts and principles; computer software applications
- Work cooperatively as a team member across multiple levels within the organization
- Skilled in assessment, planning, and managing member care
- Advanced communication and interpersonal skills
- Independent and autonomous with key job functions
- Ability to address multiple complex issues
- Flexibility and adaptability to changing healthcare environment
- Ability to organize and prioritize work and member needs
- Demonstration of strong clinical and critical thinking skills
- Regard for confidential data and adherence to corporate compliance policy
Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):
- Must be able to work under normal office conditions and work from remote office as required.
- Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
- Ability to make face to face visits (member home, provider practices, facilities) as needed to meet the member needs and produce positive outcomes
- Valid Driver's license and vehicle in good working condition as travel is required
- May be required to work additional hours beyond standard work schedule.
- Other duties as assigned and needed by the department
COVID Policy
Please note: We encourage all Point32Health colleagues to follow CDC guidance about COVID-19 vaccines, boosters, isolation, and masking. Point32Health reserves the right to adjust its requirements in response to COVID-19 trends in the communities we serve.
Disclaimer
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
$87,137.85 -$130,706.77Compensation & 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 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
PDN-a1497a69-53dc-4711-b87a-43c07cb30cc2Who 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
Point32Health is looking for a dynamic Vendor Manager to drive strategy and execution for our ancillary and supplemental benefit partners. This is an opportunity for significant ownership and accountability for an important lever for our organization. This person will be partnering with a cross section of key stakeholders to help execute our long-term strategy to create a top tier member experience while driving down costs. The ideal candidate is a seasoned contracting leader who has a track record of working collaboratively both internally and externally to negotiate, execute, and performance manage contracts and relationships.The Provider Vendor Manager supports sourcing, contract execution, and performance management for key vendor partners, including but not limited to Dental, Vision, Durable Medical, Transportation, Hearing, and other Medicare supplemental benefits. The Manager of Vendor Oversight is responsible for relationship management with assigned ancillary providers/vendors, as well as the contractual performance and maintenance of the vendor to ensure compliance, performance, and accurate payment. Builds relationships with internal vendor business owners across all lines of business.
Job Description
Strategy & Product Development
- Contractual performance and oversight. Work with internal business partners in the management of vendor Service Level Agreements and Performance Guarantees. This includes receiving vendor reports, arranging and attending Joint Operating meetings, reviewing, and documenting vendor performance and assessing corrective actions where applicable.
- Collaborate with internal and external business partners on the collection, analysis, and maintenance of relevant data.
- Strategy and development - Support the development of plans and operational solutions to address changes to vendor programs on an annual basis.
Vendor Contracting
- Work with finance and internal business owners to analyze ROI of various vendors.
- In partnership with Product Leaders, evaluate, negotiate, and recommend changes to new and existing contracts to best support P32H stakeholders.
- Responsible for the project management of contract implementations and renegotiation functions, from pre-contracting to activation, according to pre-determined internal guidelines and financial standards, while ensuring a smooth transition of services for members
Vendor Implementation & Management
- Assist in new vendor delegation implementation or de-delegation.
- Assist with management of Material Subcontractors.
- Vendor relationship management process including building, nurturing, and maintaining positive working relationships between P32H and its Vendors.
- Ensure contract requirements are adhered to, including language, terms, and reimbursement requirements.
- Ensure vendors obtain and maintain compliance with any P32H and or regulatory requirements.
- Act as resource for internal teams when consultant, business associate and nondisclosure agreements or other information to support Compliance are required.
- Drive continuous improvement in all aspects of the vendor oversight process.
- Other duties and projects as assigned.
Qualifications - what you need to perform the job.
Certification and Licensure
Education
- Required (minimum): Bachelor's degree or relevant experience.
- Preferred: Advanced degree in business or related industry
Experience
- Required (minimum): A minimum of 5-7 years' experience Managed Care, preferably at a Health Plan, in a network/procurement/compliance/regulatory/legal/product/operations/marketing or project management role. A minimum of 2 years' experience managing vendor relationships at either a Health Plan or Vendor
- Preferred: 7+ years of relevant health plan experience
Skill Requirements
- Demonstrated ability to conduct negotiations. Familiarity with contract terms preferred.
- Demonstrated experience with value-based vendor arrangements.
- Detail oriented, excellent proof reading and editing skills.
- Demonstrated ability in managing work plans & holding stakeholders accountable.
- Excellent analytical skills as demonstrated by significant ability to pull data, analyze complex data sets, and present in consumable reports/presentations to management.
- Ability to thrive in a matrix-management, hands-on environment that demands a consultative approach and solutions that span multiple environments in a business area.
- Motivated and flexible, a proponent/champion of change, able to conceptualize and envision the impact of change, and propose new ways to do business, and able to work independently and prioritize work, operating under tight deadlines.
- Strong interpersonal, presentation and communication skills.
- Requires the ability to maintain effective and productive peer relationships. Must have the ability to motivate fellow employees by fostering team spirit, an attitude of cooperation, and a commitment to the organization. Requires well-developed interpersonal skills to act in the capacity of liaison to the user community.
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.
- Anything specific to physical needs (lifting etc.)
Disclaimer
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
$97,188.00 -$145,782.00Compensation & 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 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
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