Massachusetts Green Jobs

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 (https://youtu.be/S5I_HgoecJQ) .

Job Summary

Reporting to the Chief Medical Officer, the SVP of Health Care Services leads Point32Health’s business functions that control medical cost, ensuring that the company is able to execute its strategy of selling affordable, high quality products and developing collaborative relationships with network providers. The function supports Point32Health’s three health insurance divisions that operate in a four-state New England market: Commercial (employer sponsored business), Senior Products and Public Plans (inclusive of Medicaid and Exchange business). This position requires extensive personal contact with internal and external stakeholders, providers and business partners. Critical to this executive’s success will be developing collaborative relationships with the company’s Chief Financial Officer, Executive Vice President of Markets, Chief Operating Officer, Chief People Officer and other functions across the company.

This role is part of the senior leadership team and will be on site weekly.

Key Responsibilities/Duties – what you will be doing

• Overseeing the management of functions that control medical costs, care management, utilization management, and provider contracting.

• Working with direct reports to achieve both operational efficiency for business functions as well as development of market leading affordability of care and total cost of care solutions

• Partnering with Divisional Presidents so that provider contracting and medical management strategies are product-specific, supporting the business strategy developed by Division Presidents for their respective business lines

• Responsible for developing and advancing our clinical capabilities in collaboration with the Office of the Chief Medical Officer and Provider Partnerships

• Overseeing the medical trend management process across the Enterprise, designed to understand drivers of medical trend within each Division, develop solutions specific to products and geographic markets, and implement those solutions in partnership with company resources

• Building upon the company’s strategy of developing collaborative provider relationships across business lines, identifying opportunities to improve performance in value based contracts and develop closer business partnerships with Tufts Health Plan

• Evaluating Point32Health’s approach to population health management, recommending solutions and overseeing the implementation of strategies to improve quality, lower costs and differentiate the company in the market

• Assess financial implications of strategic decisions and initiatives related to clinical within the model of care and provide recommendations to optimize financial outcomes.

• Remaining alert to trends and future federal/state policies that may impact the company’s approach to controlling medical costs and interacting with network providers

• Recruiting, developing and retaining exceptional professionals and staff who are dedicated to working with peers in the organization to control medical costs and improve Point32Health’s delivery of high quality medical care and superior service

• Working closely with enterprise technology and service functions to ensure appropriate execution of medical management programs and implementation of new initiatives

• Provide strong leadership, mentorship, and guidance to clinical teams and fostering a culture of collaboration, accountability and continuous improvement.

• Fostering an environment of and accountability

• Ensuring a high level of morale, business ethics and integrity, including sound management process and controls

• Maintaining close working relationships with other members of the corporate senior management team

• Leading by example, coaching, counseling and mentoring, and developing bench strength

Desired Outcomes:

• Aligns Health Care Services priorities to overall Enterprise strategy.

• Develops strong cross-functional relationships and collaborative approach across all lines of business.

• Position as best in class cost structure.

Qualifications – what you need to perform the job

Background & Experience

• MSN, MBA, or equivalent

• 15+ years of experience health care experience with a focus on clinical care

• Clinical licensure preferred

• Proven executive with a broad and impressive background, including a demonstrated track record of leading teams focused on medical cost control.

• Experience working with and developing positive relationships with network providers is critical, with specific experience in the New England market preferred.

• Proven track record of driving innovation, process improvement, and achieving results in a complex health care environment.

• Potential to lead teams, develop productive business relationships in a matrixed environment, and understand the drivers for highly effective clinical and contracting strategies.

• Ability to understand business strategy and formulate concise solutions to problems as well as the ability to affect change and meet business goals, monitor progress and take corrective action.

• Effective leader with superior communication, presentation and interpersonal skills and the ability to generate enthusiasm and commitment.

• Dynamic, execution-oriented executive, capable of representing the company externally while developing relationships with peers internally.

Leadership Profile

Establishing a Competitive and Compelling Vision : Orchestrates a competitive and compelling mission with an aligned set of values, goals, and a winning strategic path. This vision ensures a forward-looking aspirational framework that guides current and future decisions and choices for an entire enterprise or business unit.

Managing an Effective and Agile Plan Execution : Establishes, manages, and monitors the operational tactical annual plan to effectively accomplish the mission, vision, values, and strategy.

Creating and Cultivating Culture : Formulates, communicates, and lives the culture and tone of the organization through highlighting mission and strategy aligned citizenship behaviors, standards, and norms.

Optimizing Structure and Staffing : Attracts and selects staff and structures units, roles, and responsibilities; deploys aligned staff whose capabilities enable the organization to achieve its goals. Approaches decisions on talent utilization with both a tactical and strategic orientation.

Marshalling and Optimizing Resources : Obtains and distributes all the hard and soft resources aligned to priorities, goals, and strategy; deploys the resources that best enable the organization to do their work today and to prepare for tomorrow.

Monitoring and Appraising Results : Monitors and measures progress against plan; provides real time supportive and corrective feedback and assistance.

Representing and Responding to Stakeholders : Prepares and delivers presentations to and managers productive relationships with critical stakeholders; recognizes and responds to the diverse needs of key inside and outside stakeholders.

Intervening In and Managing Conflict : Monitors and referees the normal and inevitable individual, team, and business unit conflicts; offers assistance and direction that moves to productive resolution. Utilizes productive conflict as a source of creativity, enhanced trust, and effective interpersonal problem solving.

Investing In and Assuring Future Leadership: Actively supports a vigorous talent management and succession process that provides a continuous flow of senior talent well into the future.

Senior-Level Clinical Leadership in Related Industry Experience: Experience in financial roles of increasing scope and responsibility; credibility earned from having served at least 20 years in executive finance positions in publicly traded or not-for-profit health organizations. Significant experience interacting with the board of directors and its audit committee and managing the organization’s relationship with banks and outside auditors.

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.

#LI-TK

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 https://www.point32health.org/careers/benefits/

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.