Point32Health
Location
Quincy, MA | United States
Job description
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. To learn more about who we are at Point32Health, click here ( .
Job Summary
The Program Manager III manages projects and initiatives critical to effective Medical Policy operations. Responsibilities include management of successful implementation of departmental and cross-functional projects to support Medical Policy operational goals, processes, and procedures. The PM III will lead activities needed to operationalize/stand up Medical Necessity Guidelines (MNGs) in a matrixed environment, including facilitating meetings with key contributors throughout the organization to support MNG implementation. The PM III performs detailed policy and impact analysis to support requirements needed to implement MNGs and make recommendations for functionality based on business partner input and industry guidance. The PM III resolves issues as needed post-MNG implementation. The Program Manager III will also interact with Medical Policy and Quality leadership and within Point32 Health to accomplish successful Medical Policy operational goals.
Key Responsibilities/Duties – what you will be doing
Overall ownership and management of key processes within the Medical Policy Operations team, focusing on both on short-term initiatives and long-term strategic objectives.
Lead and manage cross-functional projects and initiatives specific to Medical Policy growth and efficiencies; Provide downstream analysis and support of MNG development; Monitor MNG performance post-implementation.
Proactive mitigation of possible program operations and integration issues; Utilize the ability to conceptualize and envision the impact of change; Propose process improvements/efficiencies to better meet the expectations of policy end-users and to satisfy regulatory requirements timely.
Apply project management skills to ensure transparency, reporting, and successful outcomes; Cultivate and maintain relationships within Medical Policy and business partners.
Ensure workflows, processes, risks, resources, and MNG quality are managed appropriately; The PM III will assess process needs through high-level gap analysis review and direct team members (PM IIs) as needed to implement process improvements.
Identify risks, concerns, and/or issues and escalate to management as needed; Exercise judgment to make decisions within Medical Policy guidelines to ensure programs/projects are effectively progressing.
Lead regular/ad-hoc cross-functional informational and/or working meetings, including effective agenda planning, facilitation, and tracking/follow-up on deliverables.
Acts as a change manager and consultant regarding operational efficiencies; Applies industry knowledge such as medical necessity guidelines, claims processing, edits, medical coding, regulatory guidelines, and research.
Other duties as assigned.
Qualifications – what you need to perform the job
EXPERIENCE (minimum years required):
8-10 years’ business or industry experience preferably in a healthcare payer environment
5-8 years’ program/project management experience, including leading significant cross-functional, high-level initiatives
Significant business process and program management experience related to the implementation of healthcare insurance business applications and/or medical policy management
A proven ability to meet deadlines
Bachelor’s degree required; Masters preferred
SKILL REQUIREMENTS:
Ability to operate in a matrixed environment, including the aptitude to coordinate/encourage the participation of internal contacts to develop and/or maintain operational processes.
Perform as an effective advocate for Medical Policy; Coach/mentor less experienced program managers.
Proactively identifies conflict/integration issues and leads team members to parse/synthesize issues of the highest complexity; Ability to identify risks, embrace the ‘big picture’ and has a proven ability to accurately assess resource allocation.
Preferred detailed content knowledge of medical policy construction/management; Able to lead dialogue on subject with minimal direction.
Ability to thrive in a matrixed, hands-on environment that demands a consultative and solutions-orientated approach that may span multiple operational areas.
Possess outstanding communication and relationship management skills, including effectively managing challenging group dynamics to effectively reach positive outcomes.
Possess high-level presentation skills, including the ability to interface with different levels of personnel.
Flexible, proponent/champion for change, ability to conceptualize and envision the impact of change, and propose new methods of process improvements.
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.
Compensation & Total Rewards Overview
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 and benefits remains in the Company's sole discretion and may be 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
Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity
Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's 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.
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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