Senior Manager, Network Performance

🔥 5 minutes ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $133.7k - $200.6k / year

⏰ Full Time

🟠 Senior

👔 Manager

👻 Ghost score 0%

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Point32Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Point32Health is a leading nonprofit health and well-being organization that provides health coverage and services for individuals at all life stages. Through its family of companies, including Harvard Pilgrim Health Care and Tufts Health Plan, Point32Health offers a variety of health plans, programs, and services encompassing medical, pharmacy, wellness, and behavioral health. Point32Health is committed to health equity and has been recognized for its inclusive practices, earning distinctions in areas such as health equity, disability inclusion, and LGBTQ+ workplace inclusion. With a focus on innovative solutions and high-quality coverage, Point32Health strives to create a better healthcare experience for its members and communities.

📋 Description

• Lead analytic support for contract negotiations, strategic initiatives, and regulatory requests • Manage analysts in designing and executing complex analyses measuring the financial impact of provider contracts and payment changes • Maintain knowledge of provider contractual arrangements, value-based reimbursement mechanisms, and cost and utilization drivers • Submit regulatory requests • Coordinate and oversee annual provider-network re-contracting for commercial business • Collaborate with Network Contracting, Provider Analytics, Accounting, Trends, and Reserving on provider risk deals • Identify opportunities to improve Point32Health’s financial position through enhanced payment arrangements • Manage development and enhancement of department tools • Coordinate quarterly provider performance assessment reviews • Participate in external provider meetings with Network Contracting staff • Manage network service costing to support Actuarial product pricing • Recruit, train, develop, and evaluate staff • Manage team workload and timelines • Support Sales RFPs as appropriate • Perform other duties and projects as needed

🎯 Requirements

• Broad, comprehensive knowledge and understanding of provider contractual arrangements • Knowledge of value based reimbursement mechanisms and key cost and utilization performance drivers • Experience supporting complex analysis related to negotiations and provider contracts • Experience managing staff and providing training and mentoring • Ability to manage data preparation for regulatory requests • Ability to coordinate annual re-contracting of the provider network • Ability to work with Network Contracting, Provider Analytics, Accounting, Trends and Reserving • Ability to evaluate and recommend new and innovative financial models and processes • Ability to manage costing of services for network product pricing • Ability to recruit, train, develop, and evaluate staff performance • Ability to manage workload while meeting quality standards and customer timelines

🏖️ Benefits

• 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 • Variable pay eligibility