Senior Manager, Network Performance

Point32Health; United States; Remote; USD 134,000 - 201,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement plans

Paid time off

Employer-paid life and disability

Tuition program

Well-being benefits

Job summary

Point32Health, Inc. is seeking a Senior Manager to lead analytic support for contract negotiations, regulatory requests, and provider contracts. You will manage staff, provide training, and participate in external provider meetings while guiding data preparation for regulatory submissions.

The role emphasizes financial modeling, contract analytics, and collaboration across departments to optimize the organization’s financial position and negotiate favorable terms.

Qualifications

• Leads analytic support for contract negotiations and regulatory requests.
• Manages staff, trains and mentors team.
• Experience with provider contracts and value-based reimbursement concepts.

Responsibilities

• Manages analysts in design and execution of complex analyses to measure the financial impact of provider contracts and payment changes.
• Maintains knowledge of provider contractual arrangements and cost drivers.
• Submits regulatory requests and coordinates annual re-contracting of the provider network for commercial business.
• Partners with other departments to ensure communication on provider risk deals and supports external provider meetings.

Job description

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.

Learn more about who we are at Point32Health.

Job Summary

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.

Job Description

Duties and Responsibilities

• 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.

Salary Range

$133,746.73 -$200,620.09

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.