Senior Manager, Network Performance

TalentBoost (Point32Health) - Canton, MA

Working with the Director of Contract Analytics and other members of the Contracting team, the Senior Manager will lead the analytic support of contract negotiations, strategic initiatives and regulatory requests. This individual will manage staff as well as provide training and mentoring to all members of the team. The Senior Manager will directly support complex analysis related to negotiations and provider contracts and actively participates in external provider meetings with Contract Managers. The individual will manage data preparation in support of regulatory requests.

Key Responsibilities/Duties – what you will be doing

  • Manages analysts in design and execution of complex analyses to measure the financial impact of provider contracts and payment changes.
  • Maintains broad, comprehensive knowledge and understanding of provider contractual arrangements including value based reimbursement mechanisms and key cost and utilization performance drivers.
  • Responsible for the submission of regulatory requests.
  • Coordinates and oversees the annual re-contracting of the provider network for commercial business.
  • Works with other departments, including Network Contracting, Provider Analytics, Accounting, Trends and Reserving to ensure open communication relating to provider risk deals.
  • Proactively leads team to identify opportunities to improve Point32Health’s financial position through enhanced payment arrangements.
  • Manages the development and enhancement of department tools to aid in standard department work. Coordinates quarterly team review of provider performance assessment. Works with analytic staff to evaluate and recommend new and innovative financial models and processes.
  • Actively participates in external provider meetings with Network Contracting staff.
  • Manages the costing of services for the network to assist Actuarial with product pricing.
  • Recruit, train, develop, and evaluates staff performance. Manages the workload of team, meeting both high quality standards and customer timelines.
  • Supports Sales RFPs as appropriate.
  • Other duties and projects as needed.

Qualifications – what you need to perform the job

  • Bachelor’s degree required; master’s degree in business administration, health policy, health economics, health services research, management science, medical sociology, or related field preferred.
  • 7-10 years of experience with 3 years of effective supervisory experience.
  • Must have proven ability to achieve goals and to deliver bottom line results.
  • Advanced Excel skills; proficiency with Access; SAS/SQL programming required.
  • 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.
  • 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.
  • Possess strong analytic and technical skills and the ability to translate complicated data into useable information
  • Ability to manage multiple projects through others meeting customers’ timelines.
  • Excellent verbal and written communication skills; outstanding interpersonal skills;
  • Creative, flexible and self-motivated with excellent judgment.

Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who 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.

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

This job has been posted by IgnyteAI on behalf of Point32Health. IgnyteAI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of IgnyteAI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Req ID: R6758

Posted On: Tuesday, September 12, 2023

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