Vice President, Network Strategy & Operations

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. 

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

The Vice President, Network Strategy & Operations is responsible for leading the execution of network-related functions underpinning the enablement of contracts supporting all lines of business. This leader will devise strategy for standardizing, streamlining, digitizing, and optimizing enabling functions that comprise the end-to-end provider experience. The scope of responsibilities include provider contracting operations/updates, and provider enrollment and credentialing. To be successful, the VP, Network Strategy & Operations will have awareness of cross enterprise dependencies and will collaborate cross functionally with various functions within each Point32Health line of business. This role requires innovative thought leadership and will be key to modernizing Point32Health’s interface with its provider network(s) with both local and national partners. This modernization includes process scrutiny, optimization and transparency, and digitization of rote processes. The role also requires innovation related to the operating model for engaging providers broadly, and specifically in getting provider partners to collaborate with the plan in pursuit of modernization of co-dependent processes (e.g. enrollment, credentialing, roster integrity, provider data integrity).

Job Description

DUTIES/RESPONSIBILITIES – what you will be doing:

• Lead the Network Operations Function. In collaboration with LOB and SLT leadership, overlay an operating model that reflects the integrated entities’ strategic targets
• Oversee contract implementation, ensuring all key terms are correctly configured in claims administrative platforms
• Ensure continual innovation and improvement on implementation processes: seize opportunities to reduce steps, redundancy, and to produce ‘single process” across LOBs
• Ensure excellence within the Provider Operations (provider enrollment & credentialing)
• In collaboration with lines of business (LOB), oversee the strategic development and implementation of provider network strategy and integrity
• Other duties and projects as assigned.

QUALIFICATIONS – what you need to perform the job

Certification and Licensure

Education

• Required (minimum): Bachelor’s degree
• Preferred: Master’s degree

Experience

• Required (minimum):
  • Minimum 10 years of professional experience.
  • 5 years health plan experience required
  • Subject matter expertise in network operations, provider data issues, and health plan operations broadly
  • Experience influencing and building strong working relationships internally with key stakeholders and external with providers
• Preferred:

SKILL REQUIREMENTS:

• Excellent leadership skills to guide, inspire and develop a high performing team of professionals
• Committed to empowering and developing talent through mindful listening, continuous coaching and feedback
• Builds alignment and consensus to move decisions forward; Empowers appropriate decision-making within levels of the team
• Results oriented, capable of clearly translating strategic objectives into implementable processes that drive outcomes
• Exceptional communication skills to connect effectively with all levels of management and work cooperatively as a team member
• In-depth and working knowledge of the whole provider data ecosystem, including up and downstream process implications and impacts.
• Serves as a culture steward, creating a positive working environment

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.

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.

Salary Range

$220,000.00 -$270,000.00

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 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/

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.

Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org