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Point32Health Director, Network Integrity and Innovation 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

The Network Integrity and Innovation Director will lead efforts to transform the customer experience, optimizing the Point32Health provider network experience through operational excellence and maximized efficiency. In this role, you will advise on best practices for developing new network offerings and pinpointing opportunities for streamlining the network “platform” to ensure smooth handoffs between operational functions to drive transparency, low-touch, and digitized experiences across the entire provider experience. Operational improvements will include reviewing and advising on provider recruitment, credentialing/enrollment, provider network builds, contract configuration, and provider directory integrity. In performing these activities, you will ensure that processes are cohesive and streamlined from end to end, that economies of scale are leveraged, and that any duplicative or outdated workflows are eliminated.

This highly collaborative role will require partnership with key stakeholders, facilitating cross-functional team collaborations that support executive leadership and stakeholders, in developing and prioritizing new business initiatives, process innovation, and position Point32Health as the leader in delivering wellness to its members by way of a digital and friction-free provider experience.

Key Responsibilities/Duties – what you will be doing

  • Evaluate key process deficiencies impacting provider experience, articulating both the requirements for addressing, and also the path to resolution of these process deficiencies. The development of the business strategies and of the triage and prioritization should be inclusive of short and long-term enterprise goals and objectives.

  • Lead and advise on operational aspects of the Commercial, Public Plans, and Medicare Advantage, and Behavioral health network build, operation and optimizing.

  • Engage with Point32Health business leaders and with key areas of the business to enable strategic goals; specifically, lead network operations work for creation of new products and new programs

  • Identify opportunities for innovation and process improvement by understanding problems, needs, and ideas from the business, the customers (employers, providers, brokers, members).

  • Leverage learning from strategic projects to devise standard processes and platforms from which to scale the business, add new networks, and speed time to market for new products.

  • Build a pipeline of ideas, manage the pipeline, and prioritize the pipeline through criteria that ensures alignment to the strategic goals and desired focus areas.

  • Jointly, with the business leadership, pitch prioritized ideas to senior executives to secure approval and funding to advance through the innovation process.

  • Track and report on ideas in the pipeline, on active initiatives in the innovation funnel/pipeline, and on pilots that are in development and getting launched.

  • Prioritize projects associated with addressing process deficiencies, including ROI analysis and cross-functional resource needs.

  • Dive deep into Point32Health’ provider-facing capabilities, and recommending strategies to improve our offering and to accelerate our goals (Membership, Financial, NPS, etc).

  • Work with internal stakeholders across the product, operations, P&L, actuarial, plan design, finance, IT, legal, business development, sales, and marketing teams to access resources, and to scope implications of provider projects and their impact upon other stakeholder areas

  • Develop an implementation plan laying out timelines and milestones; drive publication, and awareness, of a provider experience roadmap

  • Other duties and projects as assigned.

Qualifications – what you need to perform the job

EDUCATION, CERTIFICATION AND LICENSURE:

  • Undergraduate Degree required, Master’s Degree preferred or equivalent experience in Healthcare,

  • An understanding of Agile methodology

EXPERIENCE (minimum years required):

  • Experience leading cross functional teams and executing process improvement.

  • A minimum of 5 years of experience in the New England insurance market.

  • In-depth technical understanding of provider data, databases, and provider directory creation and maintenance.

  • 15+ years of professional experience in the health insurance market, including hands on experience with carrier strategy and enabling operations.

  • Expertise in digital tools, database design, and cross-functional collaboration and resource utilization

  • Experience leading long-term projects from inception

  • Strong preference for experience and knowledge of healthcare or health insurance

SKILL REQUIREMENTS:

  • A true innovator with a passion for making an impact

  • A team player who is able to effectively work across multiple functions, cultures and personalities in a cross-function/cross-departmental setting

  • Respect the talent and unique contribution of every individual and treat all people in a fair and equitable manner.

  • Successful experience working with and being a trusted advisor to business management

  • Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.

  • Be accountable for delivering high-quality work. Act with a clear sense of ownership.

  • Bring fresh ideas forward by actively listening to and working with employees and the people we serve.

  • Excellent written, verbal and presentation communications skills

  • Attention to detail and fact-based analysis

  • Ability to prioritize work and operate under tight deadlines.

  • Ability to build consensus across a wide range of constituents.

  • Motivation and flexibility; ability to work independently and collaboratively.

  • Excellent technical skills including ability to navigate the Microsoft suite of products (i.e., WORD, EXCEL, and Sharepoint).

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.

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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