Revolve Jobs in Usa

The Opportunity:

The Institutional Client Onboarding Analyst works directly with our Sales Relationship Managers, Service Relationship Managers, international institutional clients and consultants, international custodians, and various internal groups to on-board and maintain accounts for international institutional investors. The Institutional Client Onboarding Analyst acts as project manager to improve current processes and resolve operational issues associated with the complex workings of international accounts that trade in overseas equity markets.

The Day-to-Day:

* Manage the on-boarding of new institutional segregated and fund accounts
* Subject matter expert as it relates to international institutional funds and separately managed accounts
* Research and resolve operational issues pertaining to international institutional investor accounts, at times working with other groups in the process
* Assist the Institutional Client Services Relationship Managers and Sales Relationship Managers with complex client service requests
* Assist the Institutional Client Operations Team Leader with the ongoing development of the Institutional Client Operations Team members including ongoing training, workflow management and peer reviewing sensitive items
* Create, develop, document and implement workflows and process improvements to serve the needs of our international institutional investors as they relate to additions, withdrawals, account set-up, and changes to their accounts
* Responsible for understanding and documenting the nonstandard operational issues typical of accounts trading in international markets, directed brokerage relationships, and other unique institutional trading operations
* Responsible for understanding and documenting the nonstandard operational issues typical of accounts trading in international markets, directed brokerage relationships, and other unique institutional trading operations
* Coordinate with international institutional custodians to support the trading, implementation, and operations aspect of institutional accounts
* Understand and monitor the compliance issues revolving around the international institutional industry, unique codes of ethics, and internal requirements; and create, document and implement policies and procedures
* Coordinate contract negotiation between our clients and internal teams; including Legal and Senior Management

Your Qualifications:

* Bachelor's degree or equivalent combination of education and experience required
* Experience in institutional financial Operations/Onboarding required (5+ years)
* Experience with fund sub-distributor and/or database platform support preferred
* Highly developed qualitative and/or quantitative skills required
* Excellent project management skills and experience
* Excellent verbal and written communication skills
* Ability to adapt to changes in a fast paced, team environment
* Ability to prioritize workload and manage time across various tasks
* Proficient in Microsoft Office software

Why Fisher Investments Europe:

The global Fisher organisation distinguishes itself by putting clients first, providing unmatched service, and taking a personalised approach to investing. You can feel confident knowing that we align with our clients' best interests by using a simple and transparent fee structure and recognised European custodians.

It's the people that make the Fisher purpose possible, and to help our employees meet their long-term goals, we offer an array of benefits, including:

* 100% paid premiums for our top-tier supplemental medical, dental and annual health screening plans for employees and their qualified dependents
* 28 days annual leave, with the ability to purchase up to 3 additional days per year, plus up to 8 paid holidays
* Enhanced maternity pay package with 16 weeks' top up to full base pay for eligible employees
* $10,000* fertility, hormonal health and family-forming benefit
* A retirement pension plan, featuring a 9% company contribution of base pay with an additional company match of up to 5% of base pay on personal contributions
* Gym subsidy of up to £50 per month
* Employee Assistance Program and other emotional wellbeing services
* A collaborative working environment that practises ongoing training, educational support and employee appreciation events
* This is an in-office role. Based on your role, tenure, and performance eligibility you may have the opportunity to participate in our hybrid work from home program. This program is subject to change.

*Employees residing outside of the US will be eligible for the $10,000 equivalent in their local currency.

FISHER INVESTMENTS EUROPE IS AN EQUAL OPPORTUNITY EMPLOYER

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 -$154,552.38

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 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-d2449e29ed6a

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

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 -$121,826.77

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 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-88a7808245fa

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

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 -$224,697.14

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 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-dbfaf1865913

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 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 -$95,570.58

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 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-7cef85f11f9f

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 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 -$130,706.77

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 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-f0c67ef05a38

Hours:

40

Schedule:

This position is remote eligible for up to 40% of the time after a 90-day training period. Monday - Friday 8:30am - 5:30pm with one night per week 10:00am - 7:00pm. Must work one Saturday per month on a revolving schedule from 9:00am - 12:00pm. Must be flexible to meet current and future business needs.

Comprehensive Benefits:

ESL offers a competitive benefits package which focuses on providing a work life balance for all employees. Our benefits include robust options such as our wellness program, family assistance plan, 401k with match, paid volunteer time and Learning & Development training among many others.

Pay and Incentive Plan:

Starting Pay: $24.66 per hour

In addition to competitive pay and benefits, we offer an annual performance-based incentive that rewards eligible employees for their contributions to our success.

Purpose:

This position is accountable to contact members that are delinquent or at risk of loss on their loans/accounts via multiple communication channels. A Loan Payment Solutions Representative must balance their communication skills, understand the proper financial practices and regulatory compliance requirements in order to recover outstanding debts and minimize the overall loss to ESL. This position also requires the ability to properly negotiate with each member and provide all solutions available. Multiple conversations and communication channels to each member might occur to make contact.

Accountabilities:

Member Experience and Financial Impact

• 
  
• Contact all accounts assigned through the various communication channels, based on risk and loss levels to attempt collection resolution via issue identification, loss recognition, and problem resolution resulting in minimization of loss and maximization of return to ESL.
  
• Handle calls professionally, empathetically and effectively with the ability to de-escalate a situation when necessary.’
  
• Have a basic understanding of all loan/product types offered at ESL in order to answer general questions.
  
• Negotiate payment arrangements and recommend ad hoc solutions to the member with proper approval from appropriate designated team members.
  
• Review full scope of member relationship and recommend/refer to the proper outside partner when applicable.
  
• Identify potential problem/risk loss accounts and refer to their Senior LPS rep, Specialist or Supervisor for guidance/assistance, if needed.
  
• Analyze account histories to Identify and resolve payment discrepancies when necessary.
  
• Provide all requested documentation when applicable, to include payoff statements, transaction histories, and loan origination documents.
  
• Work closely with other departments to resolve complex cases.
  
• Maintain required departmental call averages as assigned.
  

Operational Excellence with Account Follow up

• 
  
• Review and make changes to customer demographics, accept on-line payments, waive late fee- based on levels of authority, review extension requests and recommend them to Specialist/Supervisor for approval, as required.
  
• Complete all assigned workflow and checklist detail for each activity.
  
• Recommend to their Supervisor those accounts requiring repossession, charge-off, foreclosure or qualifying the member for restructure/workout possibilities.
  

Employee Experience

• 
  
• Suggest/recommend alternate processes to their Supervisor to enhance overall departmental efficiencies.
  
• Cross train within the department to learn new tasks and support other areas as necessary.
  
• Attend training sessions, monthly team meetings, coaching development sessions, and other duties as assigned by the Supervisor.
  
• Openly accepts feedback to improve performance.
  
• Consistent reliability and dependability in fulfilling job responsibilities.
  

Qualifications:

• 
  
• High school diploma or high school equivalency diploma required
  
• Minimum of 2 years of collection, call center, or direct customer contact experience required
  
• Proficiency in PC usage and automated systems required
  
• Strong verbal and written communications skills required
  
• High Level of active listening skills required
  
• Good negotiation and time management skills required
  
• Outside of the box thinking
  
• Ability to multi task several different issues/accounts required
  
• Ability to work night and weekend hours dependent on departmental need required
  
• Demonstrates alignment with ESL's Core Values, mission, vision, and purpose to help our community thrive and prosper
  

Preferred Qualifications:

• 
  
• Associate degree or equivalent combination of education and experience preferred
  
• Minimum of 3 years of previous collection, call center, or direct customer contact experience preferred
  
• Ability to de-escalate situations while maintaining professionalism at all times
  
• Excellent verbal written and communications skills
  
• Proficient in PC applications
  
• Experience in a collection group, call center or direct customer facing position is preferred
  

We’re committed to diversity, equity, and inclusion. We believe we are a stronger, more successful organization because of this commitment. We strive to ensure a robust talent pool of qualified candidates with a variety of skillsets and capabilities for all our openings. We hire great people and welcome all new hires to our award-winning work environment, which has been recognized by the Great Place to Work Institute since 2010.

#LI-JF1

#LI-Hybrid

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.PDN-a12b5ca8-512d-4259-87ff-143e0488ef58

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, 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

Experience

• 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.

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

$166,666.40 -$249,999.60

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 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-4ace6668d37f

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

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 -$161,068.58

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 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-4456-4bc7-9286-19b2dfa78c85

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 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 -$130,706.77

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 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-43c07cb30cc2

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

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 -$145,782.00

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 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-9f6cbaeb-d99e-410b-a4b9-2b23100ad2c8

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 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

$84,143.20 -$126,214.80

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 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-a00193b2-ae25-4b14-93dc-0b03e9f436cb

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

Under the supervision of the Utilization Management Supervisor, the Behavioral Health (BH) Utilization Management (UM) Inpatient Clinician is responsible for conducting benefit coverage reviews and utilization management according to applicable regulatory guidelines and Enterprise contract requirements. This is VERY IMPORTANT, the schedule for this role is Tuesday - Saturday 8:30 AM - 5 PM 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

$76,114.60 -$114,171.90

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 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-a0f4fed4-a922-4f8f-a976-d7aff0bf7640

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 Contracting is responsible for contract strategy, development, negotiation, and implementation for hospitals, physician groups, and integrated delivery systems across multiple markets and products. The Director will lead a team who negotiates contracts including risk arrangements to enable high performing provider networks that support goals for membership growth, quality, and financial performance. The Director will foster and maintain strong relationships with strategic providers to support achievement of shared plan and provider objectives.

The Director is member of the leadership team and will be actively engaged in division strategy, planning and performance initiatives. This role will manage a team of contract managers and will work in a matrix environment collaborating with functions including risk adjustment, population health, finance, operations, actuarial, and sales.

Job Description

Key Responsibilities/Duties - what you will be doing (top five):

Provider Network Strategy and Development

• Develop provider networks to meet goals for access, membership, quality, medical cost, and earnings. Build and maintain high performing provider networks utilizing risk-based structures and incentives whenever possible. Identify and recommend changes to networks as needed to advance business goals.
• Collaborate with VP and President to develop network strategies, risk sharing and payment models, and performance incentives to support achievement of cost and quality goals.
• Stay abreast of trends and changes in the industry, provider landscape, and federal and state payment policies and methodologies. Utilize this knowledge to refine and advance network development and performance.

Contract Negotiation and Management

• Direct a team of contract managers to negotiate financial, operational, regulatory, and legal contract parameters with physician groups, ACOs, and hospitals to meet business goals and regulatory timelines.
• Coach, support, and train staff to devise proposals, strategies, and options for contract negotiation. Support contract negotiation as needed.
• Devise strategy, lead and negotiate agreements with largest provider systems.
• Develop and maintain optimal provider networks. Assess, monitor, and manage network adequacy to meet federal and state regulations. Proactively identify and close network gaps.
• Collaborate with Enterprise Allied Health Contracting to ensure allied health and BH/SA networks and payment terms support Medicare division needs and goals. Assess and monitor allied payment rates and recommend changes to methodology and rates to align incentives and manage expense trends.
• Collaborate with colleagues in the Enterprise Network Operations to ensure timely and accurate contract implementation, configuration, and accurate ongoing contract administration.

Strategic Relationship Management

• Develop and implement a proactive relationship management approach that supports long-term, mutually successful relationships with strategic providers.
• Engage with the provider performance team to understand and monitor provider and network performance. Advise on performance improvement plans and identify contract strategies and incentives that support performance improvement.
• Collaborate with operations, professional relations, and other functions to identify and resolve provider issues.

Stakeholder Engagement

• Proactively communicate and engage with function leaders and key stakeholders. Participate in/chair leadership meetings concerning provider strategy, network development and other issues.

Talent Management and Team Building

• Provide ongoing staff development and coaching in negotiation, performance analysis, and relationship management to enable a high-performing team of provider professionals.
• Other duties and projects as assigned.

Qualifications - what you need to perform the job

Certification and Licensure

Education

• Required (minimum): bachelor's degree in business, health care or related field.
• Preferred: Master's degree

Experience

• Required (minimum): 10-15 years of progressively responsible management experience in a complex healthcare setting. Experience in managed care contracting and experience working collaboratively with providers.
• Preferred: 10-15 years of Medicare Advantage experience.

Skill Requirements

• Energetic, goal driven leader with a proven ability to deliver results and lead teams to achieve goals.
• Strong working knowledge of managed care/risk contracting payment methodologies.
• Savvy negotiator with experience in a range of provider payment methodologies including risk. Demonstrated experience in direct, high-level negotiations with the proven ability to close a deal while maintaining relationships.
• Excellent quantitative skills with ability to synthesize financial information, create and evaluate options.
• Excellent interpersonal skills and a high level of diplomacy to anticipate, recognize and deal effectively with complex issues.
• Strong relationship skills to influence and work collaboratively with physicians and other provider leaders.
• Excellent management skills to guide, inspire and develop a high performing team.
• Ability to manage and direct multiple priorities across markets while meeting aggressive deadlines.
• Adaptable to change and ambiguous situations; able to maintain constructive behavior in challenging situations. Requires the ability to think and plan strategically. Ability to assess and address interests of the enterprise and providers
• Strong collaborator able to work effectively across functions.

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

$154,856.40 -$232,284.60

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 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-9f6cbaeb-7743-4a8d-8b0a-2fa72a6fc0f4

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

Under the direction of the Director, Clinical Pharmacy Operations, the Senior Manager, Clinical Pharmacy Operations is responsible for managing a team focused on the execution of clinical pharmacy programs and strategies to mitigate cost, improve adherence, and maintain affordability. Leads the implementation and maintenance of evidenced based, cost-effective program for all lines of business in all market segments. Guides clinical pharmacy team in the implementation of clinical programs, aligned with enterprise goals, including medical cost reduction and administrative simplification for members and providers. Ensures compliance with state and federal regulatory and accreditation requirements in all geographies. Collaborates with PBM to optimize member experience and clinical outcomes. Directs support functions for the Pharmacy and Therapeutic's committee in collaboration with the pharmacy medical director. Leads and manages the work of the clinical pharmacy team, effectively delegating as appropriate and holding team members accountable for meeting deliverables and achieving results. Sets priorities and ensures that the key deliverables of the team stay on track.

Job Description

Key Responsibilities/Duties - what you will be doing (top five):

• Lead the maintenance of enterprise formularies and pharmacy programs, for all lines of business and geographies. Lead the annual review of all formularies and clinical pharmacy strategies, including a competitive analysis, cost-benefit review of programs, and trend review by therapeutic class. Work with Pharmacy Benefit Manager (PBM) to monitor pharmacy spend and performance to identify opportunities for improved management. Ensure formulary management activities meet state and federal requirements.
• Identify initiatives for medical cost reduction, administrative cost reduction and/or market competitiveness. Lead the business evaluation and implementation through collaboration and communication with other departments and stakeholders and Pharmacy TCOC (Total Cost of Care) team.
• Represent clinical pharmacy interests at inter-departmental meetings and on project teams. Identify implications for Pharmacy Services department and facilitates/coordinates follow-up with others in the department. Disseminate information and provides periodic updates as needed.
• Hire, train, supervise and evaluate the activities of the Clinical Pharmacy Team staff. Provide coaching, feedback, and direction to staff to insure the successful achievement of their goals and that of Point32Health. Prioritize projects and initiatives and support staff in the resolution of escalated issues. Serve as a role model for staff and foster a collaborative and team-based approach both within the Department and interdepartmentally. Effectively manage change and constant prioritization based on strategic and operating goals
• Direct the research and analysis of identified problems and issues, the validation of findings and the development and communication of plans for problem resolution. Support staff in the identification and verification of problems and provide guidance in the development and implementation of appropriate solutions. Identify for the Director those issues of broader complexity and/or sensitivity which may require action by the Director and recommend solutions for those issues having broader complexity or ramifications.
• Participate in and/or lead departmental and interdepartmental meetings, including but not limited to Pharmacy & Therapeutics Committee, Drug Coverage Committee, Specialty Pharmacy committees, and Pharmacy Compliance.
• Oversees team compliance with all federal and state laws and accrediting bodies and keep abreast of marketplace developments and regulatory and licensing requirements as it relates to Clinical Pharmacy and formulary management.
• Other duties and projects as assigned.

Qualifications - what you need to perform the job

Certification and Licensure

• Licensed health care professional (e.g., PharmD, RPh or RN) with current unrestricted license in state of residence.

Education

• Required (minimum): BS in Nursing, Doctorate degree in Pharmacy (PharmD), or Registered Pharmacist (RPh)
• Preferred: Master's degree in business and/or health policy

Experience

• Required (minimum): 8-10 years' to include 6 years' related experience in pharmacy, and 2 years of supervisory experience.
• Preferred: 1 - 2 years' managed care or PBM work experience. Experience supervising in an office or clinical environment is desirable. Experience with multiple lines of business such as commercial, Medicare and Medicaid are desirable. Expertise in business process changes and leading people is also desirable.

Skill Requirements

• Strong verbal and written communication skills
• Work cooperatively as a team member across multiple levels within the organization
• Results orientation - strives to meet business goals
• Critical and Analytic thinking - must understand cause and effect, internal and external impact of business changes and Point32Health information systems
• Comprehensive knowledge of health policy, sufficient to make decisions regarding Plan benefit structures and coverage issues.
• Influencing others - particularly those outside of direct reporting relationships
• Ability to define training needs, develop training materials and administer training to small groups.
• Strong communications skills (formal and informal, written and verbal)
• Coaching and Mentoring - primarily of direct reports, but also of others
• Must have commitment to excellence in customer service
• Considers creative alternatives to traditional/conventional practices and takes risk when appropriate to the situation.
• Ability to handle multiple demands--must be able to balance multiple priorities

Complexity

• Expert knowledge of the principles and practices of pharmaceutical science. Working knowledge of managed care and policy development.
• Requires analytical ability, highly developed oral/written communication skills. Must be self-motivated and capable of working independently with minimal supervision. Must be capable of organizing, facilitating, and managing several projects simultaneously.
• Requires a high degree of initiative and excellent judgment to make decisions regarding clinical pharmacy issues in an extremely complex and often politically charged environment.
• Must be flexible and able to constantly review and reset priorities; often daily. Must be able to handle multiple projects simultaneously. Ability to appropriately identify emergency situations and follow through with the appropriate protocol.

Personal Contacts

• Must be able to work independently as well as cooperatively as a team member. Excellent interpersonal skills, cross-departmental skills required; a high level of diplomacy is necessary to anticipate, analyze and effectively resolve difficult situations and politically sensitive concerns. Frequent communications with Point32Health staff.
• Capable of communicating with physicians, pharmacists, and other health care specialists as well as a broad range of non-health care professionals. Ability to maintain harmonious working relationships and to communicate effectively both verbally and in writing with health care professional, other departments, network providers, state and federal regulatory and enforcement agencies, pharmaceutical manufacturers, and professional colleagues.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

• Ability and willingness to work irregular hours and to travel in state and out-of-state for job-related purposes, as necessary.
• Must be able to work under normal office conditions and work from home as required. Occasional evening, weekend, early morning, or extended day work may be required.
• Must hold a valid driver's license and have access to and ability to drive an automobile during regular working hours and irregular hours 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

$151,888.80 -$227,833.20

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 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-a0682c3d-7cfa-4515-996d-7d0fa6c6d590

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 Government Affairs Manager is responsible for supporting legislative and regulatory advocacy efforts across Point32Health's geographic footprint, with a focus on the Massachusetts and Rhode Island markets.
Working with business owners, the Government Affairs Manager develops and communicates Point32Health positions on priority legislation and regulation to advance strategic, operational and business priorities.

Job Description

Key Responsibilities/Duties - what you will be doing (top five)

• Identify and prioritize legislative and regulatory proposals of strategic, financial and operational importance to the organization.
• Develop and communicate Point32Health's position on priority legislation and regulations Monitor legislative and regulatory activity.. Work with trade associations and retained lobbyists on advocacy and outreach on key issues.
• Work with internal business owners to evaluate and understand regulatory and legislative proposals and to develop advocacy positions.
• Communicate and explain Point32Health's position on proposals to lawmakers, regulators and other health care officials. Manages our reputation and relationships with legislators, regulators and other health care officials.
• Manage relationships with external lobbyists and trade organizations to execute on our objectives.
• Develop and maintain expert-level of health care policy knowledge and communicate to internal business owners. Serve as a subject matter expert for business leaders and help drive positive change.
• Other duties and projects as assigned.

Qualifications - what you need to perform the job

Certification and Licensure

Education

• Required (minimum): Master's degree in Business Administration or Public Health,
• Preferred: J.D.,.

Experience

• Required (minimum): Must possess at least 3 years previous experience working on healthcare policy matters in a health plan, health care system, legislative or regulatory environment.
• Preferred: Demonstrated experience with Medicaid products preferred.

Skill Requirements

• Experience leading and communicating legislative and regulatory efforts to various stakeholders and developing advocacy strategies.

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

$96,123.20 -$144,184.80

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 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-a11d397d-c5cd-428e-8aac-c35f2b464f7f

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

Reporting to the VP of Contracting, this role will be a Contracting enterprise strategic partner for the organization. The SBL is the central point of contact for Contracting initiatives. As such they will provide leadership, consultation, facilitation, and insight to develop the annual contracting plan, adjust the plan as necessary throughout the year, and ensure Contracting delivers on the agreed upon strategic initiatives that are critical to the line of business goals and long-term strategy. This individual is accountable for assessing internal and external resources/opportunities, as well as gathering and synthesizing data to make sound business recommendations in support of our line of business strategy. In collaboration with Provider Partnerships, this individual works with cross-functional teams to advance complex large-scale projects from strategy to implementation. This individual collaborates closely with Sales, Finance, Product, Medical Management, Government Relations, Marketing, and IT resources to assure data driven business needs are effectively communicated, building consensus among vested parties that results in alignment and timely execution of the business and technology deliverables.

Job Description

Key Responsibilities/Duties - what you will be doing:

• In conjunction with Contracting Directors and Director, Provider Partnerships Strategy and Analytics, develop and update all line of business annual network strategy for Ancillary and System Contracting for Contract leadership review.
• Manage complex initiatives and/or alliances that require integration across multiple business units. Gather cross functional internal/external inputs and provide content expertise to make high level recommendations to Contracting leadership.
• Develop, maintain, and reinforce program strategy and scope; serve oversight role in ensuring programs are on track, on budget, and progressing towards business goals identified.
• Develop, manage, and lead effective and collaborative program and team structures to ensure that discussions are appropriately focused, timely, and incorporate input from internal and external subject matter experts.
• Proactively identify implications and challenges to success, and develop cross-functional strategies to address/resolve and get buy-in; escalate as needed to achieve timely resolution of issues
• Develops and coordinates reports, queries and/or extracts to support data requests and analytics related to strategic initiatives
• Represents Contracting as an SME for line of business/product forums
• Other duties and projects as assigned.

Qualifications - what you need to perform the job

Certification and Licensure

• N/A

Education

• Required (minimum): Bachelor's degree in business and/or related field or equivalent experience
• Preferred: Master's degree preferred

Experience (minimum years required):

• Required (minimum): 5-7 years of provider contract related experience
• Preferred: 7-10 years of general work experience

Skill Requirements

• Must have extensive knowledge of the health plan industry and its customers, as well as expertise in strategy development/planning and project leadership.
• Strong analytic skills, with a clear understanding of dynamics of financial models, provider incentives, and contracting business processes.
• Well developed, working knowledge of managed care, insurance, and provider dynamics.
• Advanced Excel and PowerPoint skills
• Must have a proven track record of working effectively with people and processes at multiple levels
• Requires strong leadership, communication, negotiation, and conflict resolution skills.
• Strong presentation/facilitation, as well as business analysis skills preferred.

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

$115,072.80 -$172,609.20

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 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-a13d6888-b321-4a2d-ac47-945a9f7ef6b4

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 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

$84,238.43 -$126,357.65

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 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-a0dad67e-b2dd-414b-afc5-f4ed281b7512

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 Manager of Allied Health Contracting oversees a team of Contract Managers, Associate Contract Managers, or other staff as appropriate who oversee negotiating with allied health providers. This individual may be the lead on managing certain allied contracts and will assist team members during negotiations by providing oversight and assistance with the negotiations of financial and legal terms. The Manager, Allied Health Contracting will work closely with the Director, Allied Health Contracting and Vice President as applicable on negotiation strategy development and execution. Additionally, this individual will work closely with contract management staff on the day-to-day negotiations and implementations to ensure smooth and timely transitions of key contract elements.

Job Description

Key Responsibilities/Duties - what you will be doing (top five):

• Supervise and support contract management team's negotiations of contractual arrangements with established or potential network providers, within budgeted targets and regulatory requirements. Oversee and ensure accurate and complete analytic requests to support contract negotiations; oversee the development of contract documents. Participate as the lead in negotiations when appropriate and directly manage high cost, high volume contracts.
• Understand, with a high degree of specificity, important business aspects such as budget models, unit cost trend, and other analytics utilized by Point32Health to understand performance, financial or otherwise, of the allied provider network. Work closely with the contract management staff and legal department to ensure contract provisions are consistent across providers and ensure all applicable legal terms are included in the signed contract.
• Oversee the staff of Allied Health Contract Managers and Associate Contract Managers, providing coaching, feedback, and direction to allow team members to develop subject matter expertise and independently manage the ancillary service lines assigned to them
• Assist contract management staff and Director to develop Point32Health position on key issues relevant to the contract negotiation. Manage and position the negotiation so that Point32Health meets the key objectives that have been identified; communicate status of negotiations and document key financial and legal terms
• Lead and/or participate in cross functional meetings as required; lead internal ad hoc discussions to address contracting issues.
• Other duties and projects as assigned.

Qualifications - what you need to perform the job

Certification and Licensure

Education

• Required: Bachelor's degree
• Preferred: Master's degree

Experience

• Required: 5-7 years of professional experience
• Preferred: 8-10 years of experience in contract negotiations, including familiarity with payment methodologies.

Skill Requirements

• Contract negotiation experience is required, with ability to understand and interpret all aspects of a contract: financial, legal, and operational with emphasis on implementation of contract terms
• Demonstrated strength in finance to support financial contract components and analysis
• Ability to research, interpret and communicate complex issues
• Ability to understand the nuances of Tufts Health Plan's commercial and Medicare Preferred product lines and the unique operational and financial features associated with each
• Ability to maintain effective and productive staff/management relationships, including the ability to motivate staff by fostering team spirit, an attitude of cooperation, and a commitment to the organization
• Ability to understand the nuances of Tufts Health Plan's product lines and the unique operational and financial features associated with each
• Advanced analytic ability with proficiency in Microsoft Word, Excel, and PowerPoint applications

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

$112,724.00 -$169,086.00

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 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-a0946dba-6827-4734-8e97-6ce517290e7a

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

Perform vendor/vendor management activities across Indirect Categories (including IT, Operations, Professional Services, Marketing, etc.), particularly focused on contract performance measures, quality activities, and risk management. The Procurement Category Manager provides core expertise in the four process domains (i.e., Performance Management, Financial Management, Relationship Management, and Risk Management) in support of sourcing and contract execution lifecycles. The Category Manager is responsible for managing the strategic relationships of vendors with a primary goal of driving outcomes from the vendor base which achieve optimum value for Point32Health, and mitigating future potential risk, while supporting analysis and reporting of vendor performance to the appropriate stakeholders.

Job Description

DUTIES/RESPONSIBILITIES - what you will be doing:

• Contract Review, Modification, Negotiation
  • Work with business owners and the legal department to create and negotiate vendor contracts.
  • Drive meaningful cost savings and extract maximum value from Point32Health vendor base via negotiations on price, service levels, efficiency, payment terms, etc., while working in conjunction with the Legal Department, business owner, and other impacted departments (i.e. Security, Privacy, Compliance, etc.)
  • Perform project management of contractual process from vendor selection through contract execution.
  • Coordinate business, procurement and legal objectives for the business requirement, costs, quality, risk, etc.
  • Prepare and maintain project plans, appropriate milestone, and related schedules.

• Competitive Bidding, Negotiations and Cost Reduction Initiatives
  • Follow all policies and procedures regarding the sourcing, selecting, and managing vendors. Responsibilities include:
    • Develop Request for Information/Proposal (RFI/RFP) documents in coordination with the appropriate project leader.
    • Manage the RFI/RFP process, acting as the main point of contact with vendors and business owners.
    • Synthesize RFI/RFP responses into meaningful, actionable summaries.
    • Build and utilize scorecards for the basis of vendor award.
    • Collaborate with Business Owners to recommend the best vendor to meet business needs.
    • Identify and include certified diverse suppliers in all competitive bidding events, in support of Point32Health's economic inclusion goals.
• Vendor Relationships & Performance Measurements
  • Measure and track vendor performance to ensure appropriate service levels are maintained with key vendors. This will be accomplished by working with vendors and business owners to establish and monitor mutually agreeable service level agreements/key performance indicators (SLAs/KPIs) and terms and conditions of the business relationship.
  • Provide feedback on performance, seek continuous improvement and innovation.
  • Work with vendors and key stakeholders to manage vendor performance and develop new capabilities.
  • When performance issues emerge, identify root causes and work with internal and external stakeholders to drive efficient resolution.
  • Identify and capture profit improvement opportunities beyond sourcing, such as demand management, process improvements, insource vs. outsource innovation, etc.
  • Regularly monitor the market for category leading practices and demand/supply shifts such as vendor consolidation, technology innovations, etc.
  • Implement strategies to best manage the vendor base for categories in scope, reviewing vendors against contracted obligations/service levels and business expectations.
• Project Management
  • Provides project management experience in situations where vendor participation is a key component to successful project implementation and that skill set is not inherent in the functional area.
• Other projects and duties as assigned.

QUALIFICATIONS - what you need to perform the job:

EDUCATION, CERTIFICATION AND LICENSURE:

• BS/BA degree in relevant area such as Business Administration, Supply Chain or Finance preferred.

EXPERIENCE (minimum years required):

• 5-8 years of relevant procurement, strategic sourcing and vendor management experience demonstrating success in positions of increasing complexity. A consistent track record of delivering business impact in a complex, corporate environment.

SKILL REQUIREMENTS:

• Experience with category management strategies, vendor management, opportunity diagnostic, strategic Knowledge and experience within indirect categories,
• Exposure to category management strategies for categories in scope, opportunity diagnostic, strategic sourcing process, vendor management with a proven track record of delivering business impact
• Strong implementation skills supported by strategic vision to drive spend management excellence in complex categories.
• Strategic, analytical, and interpersonal skills to act as an effective change agent. Demonstrated analytical, financial, problem solving, organization, and project management skills.
• Highly motivated with an entrepreneurial mindset, proactive and innovative.
• Experience working effectively in complex organizations.
• Ability to lead and influence change in the face of complexity and ambiguity.
• Excellent stakeholder engagement skills.
• Thrives in a fast paced, goal oriented, dynamic organization with time sensitive deadlines.
• Leverage market data, external expert resources, spend analytics, and cost modeling to drive fact-based decision making.
• Strong project management skills, including stakeholder timelines and meeting management skills.
• Understanding of Agreements which may include Master Service Agreements. Statements of Work, and SaaS/License Agreements.
• Knowledge of key contract terms and techniques for driving additional value and managing risks
• Ability to support, lead and conduct successful negotiations.
• Develop and manage relationships across the business to achieve key business, organizational and cross-cultural objectives.
• Demonstrated ability to develop highly functioning business relationships at senior levels both within and outside the organization.
• Knowledge of Vendor Management tools (SRM, conducting Quarterly Business Reviews, etc.).
• Technology-savvy and high competency in MS office; Advanced Excel skills and other analytics software as well as eSourcing, reverse auctions, etc.
• Excellent written, verbal and presentation skills including meeting facilitation and presentations.
• Ability to interact effectively and gain credibility with internal associates at all levels as well as external third parties.

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

$100,721.84 -$151,082.76

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 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-a1538967-6a71-4e6b-8553-1e28b5fae731