Provider Network Development Jobs in Massachusetts

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 Vice President of Network and Provider Performance Management, the Director of Network and Provider Analytics plays a strategic leadership role with the Provider Partnerships organization. The Director manages a team of managers and analysts, working in a matrix environment to support and collaborate with colleagues from System Contracting, Ancillary Contracting, Actuarial, Sales and Provider Performance. He/she oversees the development and timely delivery of relevant and meaningful financial analyses in support of Point32Health's provider contracts and network performance for all commercial and government payor lines of business.

Job Description

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

• Proactively identify and oversee the development of analyses, models, and tools to offer an informed view of provider, network, and contract performance
• In collaboration with System and Ancillary Contracting leadership, formulate and execute on strategies to improve unit cost, standardize reimbursement methodologies, and maintain competitive provider networks
• Provide direction and define approach and parameters for overall reimbursement strategy and payment methodologies, with the goal of standardization, optimization, and transparency. Oversee development of provider rates in line with negotiated terms
• Oversee the submission of regulatory submissions and requests
• Monitor, analyze and report on competitive position for all applicable Point32Health markets
• Produce accurate and timely reporting on network access and adequacy, ensuring standards are maintained and gaps are appropriately addressed
• Engage with Sales team to provide compelling information and reporting in support of employer account engagement, actively participating as a subject matter expert in cross-departmental as well as external provider and broker meetings.
• Actively represent the Provider Partnerships organization in Corporate Data & Analytics, Finance, Actuarial, Trend, Health Care Services, Information Technology, and other department and enterprise governance forums. Provide thought leadership, express business needs, and manage relationships with key internal constituencies
• Accountable for ensuring the team adheres to enterprise data and analytics governance standards, policies, and procedures
• Recruit, retain and develop talent. Coach and support staff in analytics, leadership and relationship management to enable a high-performing team
• 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 administration, finance, or a related field
• Preferred: Master's degree preferred, or relevant experience

Experience

• Required (minimum): 10-15 years of progressive analytic, financial, project and/or operational experience in healthcare with 3 or more years of effective supervisory experience.
• Preferred: 10-15 years of experience in healthcare analytics, provider network management, or a related field, with a strong background in data analysis and leadership roles. Previous experience director-level position.

Skill Requirements

• Energetic, goal-oriented leader with a proven ability to deliver results and lead teams to achieve goals
• Strong working In-depth knowledge and understanding of managed care concepts and the financial relationship between payers and providers; solid knowledge of health care claims data, coding schemes (ICD-9/ICD-10, CPT/HCPCS, DRGs), and health status risk adjustment
• Prior experience with Business Intelligence tools such as MicroStrategy, Tableau or SAS
• Excellent quantitative skills with ability to synthesize financial information, create and evaluate options
• Ability to manage and direct multiple priorities across teams while meeting aggressive deadlines
• Must have proven ability to work effectively across all levels of the organization on complex issues
• Excellent verbal & written communication skills
• Energetic and proactive individual who strikes the right balance between self-initiative and collaboration with others
• Demonstrated ability to master new content quickly
• Strong analytic and technical skills with the ability to translate complicated data into useable information
• Excellent verbal and written communication skills
• Must have the ability to lead/mentor a team of staff effectively, meet changing business priorities, think strategically, understand and have insight into health care industry with an emphasis on managed care and finance related issues.

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

$160,392.80 -$240,589.20

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 andbenefits remains in the Company's sole discretion and maybe modified at the Company's sole discretion, consistent with the law.

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

• Medical, dental and vision coverage

• Retirement plans

• Paid time off

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

• Tuition program

• Well-being benefits

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

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

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

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