Vice President, Medicaid & Exchange at Point32Health, Inc. in Canton, Massachusetts

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 VP of Medicaid and Exchange is responsible for managing Point32Health's long-term success in the Medicaid and Massachusetts Direct QHP segments. This individual is accountable for the P&Ls of the Massachusetts and Rhode Island Medicaid markets and the Massachusetts Direct QHP product. The role is focused on achieving membership and operating margin performance. The VP will develop, execute and manage the product strategy, end-to-end performance management, and overall strategic plan objectives for the Medicaid and Direct QHP lines of business, as well as any future markets that Point32Health expands these offerings to. These critical functions will be performed according to the overall strategic plan and annual business plans established by Point32Health.

Reporting to the President, Government Markets, the VP of Medicaid and Exchange is accountable for the overall success of the Medicaid and Direct QHP businesses, as measured by traditional KPIs such as P&L performance, membership growth, quality ratings (NCQA), and compliance, as well as strategic performance drivers such as innovation and market impact. The VP's responsibilities are carried out by effectively managing relationships across several critical domains, including state regulators, ACO partners, CMS, and internal departments in a matrixed enterprise. This role works closely with a cross-section of business and functional leaders and maintains direct oversight over a team that manages day-to-day product strategy, as well as product-related issues for customers and other stakeholders.

Key Responsibilities/Duties - what you will be doing

P&L Management & Internal Collaboration

• Full P&L responsibility for the Medicaid and Exchange markets, including attainment of profit and loss, revenue, membership enrollment and retention, market share, quality ratings (NCQA), medical and administrative expense targets, as well as member services SLAs, regulatory and compliance requirements for each market segment.


• Oversee the development and management of all Medicaid and Exchange products offered by the organization, including directing relevant procurement cycles. Maintains accountability for bid and procurement implementations. Partners closely with Actuarial on the pricing strategy for Direct QHP product.


• Accountable for implementation and maintenance of products according to regulatory requirements, as well as product strategies and annual business plans as approved by senior leadership. VP will be responsible for executing against like-product expansions into other states or markets, including leadership on procurements and product filings as well as P&L ownership for those newly established markets.


• Identify, articulate, and prioritize initiatives to be delivered to support product success.


• Collaborate with internal business functions (Finance, Actuarial, Population Health Management, Enrollment, Operations, Marketing, Provider Partnerships, Legal, IT, etc.) to execute on performance management and improvement initiatives for the Medicaid and Exchange markets. Jointly develop performance metrics with internal colleagues that help hold the organization accountable in a collaborative and productive manner.


• Monitor adequacy of revenue, risk adjustment, medical cost management and collaborates with clinical teams to develop and monitor key member utilization KPIs; monitor the administrative budget and allocations to the Medicaid and Exchange market segments.


• Intervene and escalate any issues that pose a risk to state or CMS compliance requirements.


• Provide periodic reporting to enterprise leadership on comprehensive market performance, highlight opportunities and risks, and recommend areas of focus.


• Closely collaborate with Provider Partnerships on strategic network contracts and partnerships; VP holds Provider Partnerships team accountable for execution. Builds and maintains relationships with provider groups.


• Maintain strong partnership with marketing and community relations teams to ensure compliant and adequate lead generation to drive sales, timely and effective communications with members and provider partners, and positive brand awareness to promote active selection among eligible populations.


• Build and maintain effective internal and external relationships, centered around trust/credibility, and resolves issues in a timely and responsible manner.


• Other duties and projects as assigned.

Regulator Relations: Working closely with the Government Affairs department and other functional teams in the enterprise to:

• Manage the collaboration with state regulators and Centers for Medicare and Medicaid (CMS) to ensure the organization's dependability and rigor in its day-to-day fulfillment of program requirements.


• Proactively engage the State in policy advocacy and program negotiations, convening internal cross functional coalitions and external allies as appropriate.


• Continuously improve overall relationship with the State as measured by visibility into State priorities and the ability to provide constructive inputs into program development.


• Build relationships with regulatory bodies with new states of product expansion.

ACO strategy and partnership management:

• Lead the development of ACO partnership strategy and continuously strengthen the governance structure of the ACO partnerships.


• Develop and manage strategic relationships with ACO executives and clinical leaders in an increasingly sophisticated partnership model, with growing ability to drive innovative collaborations and change providers' organizational culture.


• Oversee day-to-day business relations with ACO partners, address operational issues, and ensure compliance with state requirements and milestones.


• Support ACO organizations' infrastructure development, performance improvement and accountability enforcement towards an integrated care management model, in close collaboration with the Office of the Chief Medical Officer and Healthcare Services leaders.


• Facilitate 3-way relationship that includes Point32Health, ACOs and the State, leading joint advocacy on behalf of the partnerships.

Qualifications - what you need to perform the job

Background & Experience

• MBA or other advanced degree required.


• 8-10 years of senior leadership experience in health care/managed care, specific state-level public affairs, business, and health care experience necessary.


• Experience with complex matrixed responsibility in a large organization.


• Proven experience as a major player in the local marketplace, operating from visible and influential positions.


• Effective leader, problem solver, able to function independently, flexible, change agent.


• Familiarity with a range of diversified product lines and competitor products.


• Excellent communication skills, proactive and innovative, organized, team player, positive attitude, strategic and business planning capabilities.

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.

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.

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 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.

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

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