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Point32Health Director, Network Contracting in Canton, Massachusetts

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.

Job Summary

Reporting to the Vice President of Medicare Provider Network and Performance ManagementContracting, in this highly visible role, the Director of MedicareProvider Network Contracting is responsible for contract strategy, development, negotiation, and implementation for hospitals, physician groups, and integrated delivery systems for medical and behavioral health services for the Medicare, Medicaid and Commercial suite of products across multiple statesMedicare 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 Provider NetworkMedicare leadership team and will be actively engaged in division strategy, planning and performance initiatives. He/she 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.

Key Responsibilities/Duties – what you will be doing

DUTIES/RESPONSIBILITIES :

Provider Network Strategy and Development

  • Develop Medicare Advantage, Medicaid, and Commercial 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 Contracting and Line of Business leadership 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 key provider systems.

  • Collaborate with Enterprise Allied Health Contracting to ensure allied health network and payment terms support each product line’s needs and goals.

  • 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, provider 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

QUALIFICATIONS

EDUCATION, CERTIFICATION AND LICENSURE:

  • Bachelor’s degree in business, health care or related field.

EXPERIENCE:

  • Minimum of 10 years of progressively responsible management experience in a complex healthcare setting.

  • Previous experience in managed care contracting and experience working collaboratively with providers.

  • Medicare Advantage experience highly desirable.

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.

CONFIDENTIAL DATA:

  • All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential.

  • Will be exposed to and required to deal with highly confidential and sensitive material.

  • Must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

  • Requires a high degree of confidentiality with regard to the financial and political issues associated with contractual agreements.

  • Requires confidentiality regarding the health plan’s initiatives, strategies and product related contractual development.

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.

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.

COVID Policy

Please note: As of January 18, 2022, all employees — including remote employees — must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

At Point32Health, we strive to be a different kind of nonprofit health and well-being company, with a broad range of health plans, and innovative tools that make navigating health and well-being easier, guiding our members at every step of their health care journey to better health outcomes. We are committed to providing high-quality and affordable health care, improving the health and wellness of our members, and creating healthier communities across the country. The Point32Health name is inspired by the 32 points on a compass. It speaks to the critical role we play in guiding and empowering the people we serve to achieve healthier lives. Our employees are hard-working, innovative, and collaborative. They look for opportunities to grow and make a difference, and they help make us strive to be one of the Top Places to work in New England.

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