Director, Medicare Business (Massachusetts) 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 Director is responsible for the overall success of Point32Health's Medicare offerings, including the Medicare Advantage and Medicare Supplement product lines. In addition to managing existing products and markets, the Director will lead or play a key role in the evaluation of potential market expansion opportunities, and subsequent implementation. The Director is accountable for profit and loss results, membership growth and retention, quality ratings (Stars), medical and administrative expense targets, and regulatory/compliance requirements.

The Director leads a team that establishes, implements, and performance manages product strategies across a highly matrixed organization, and externally, with a broad set of stakeholders (e.g., providers, brokers, vendors, etc.) Key elements of the product strategy include, but are not limited to product design, margin targets, membership targets (sales and retention), competitive positioning, marketing strategy, care management model, and provider network. The Director is responsible for ensuring identification of the deliverables necessary to achieve the strategy and coordinating with leaders across the organization to facilitate implementation.

The Director is responsible for establishing a management structure that monitors the performance of the chosen strategies relative to established targets, including identifying key performance indicators. The Director works closely with a cross-section of functional teams (sales, operations, clinical services, population health, quality, network management, legal, compliance, finance, marketing, etc.) to establish shared accountability for the achievement of these performance objectives.

For potential expansion markets, the Director will coordinate a robust evaluation of market potential (growth/financial) including the competitive landscape, provider environment and develop the product strategy recommendation for senior leadership.

Across existing and potential new markets, the Director is responsible for establishing and maintaining productive relationships with senior leaders of strategic partners, including but not limited to providers, regulators, advocates, and vendors.

Key Responsibilities/Duties - what you will be doing

• Develop multi-year market strategy.


• Ensure the implementation of initiatives critical to strategic success, including the management of strategic partner relationships and/or internal performance improvement projects.


• Establish key performance objectives, monitor results, and coordinate data-driven strategic recommendations across a variety of domains including medical trend, financial and operational performance, member/provider experience, care management, network management and quality.


• Coordinate closely with enterprise leaders, including medical and care management leadership, actuarial, operations, sales, marketing, network contracting, on the achievement of shared objectives.


• Develop recommendations to optimize ongoing product positioning based on market data, business, and competitive intelligence data.


• Develop productive working relationships with a wide variety of external stakeholders, including providers, regulators, and advocates.


• Communicate product performance to internal stakeholders, including senior leadership.


• Evaluate potential near-term opportunities, including alongside potential strategic partners.


• Develop and present strategic recommendations to senior leadership for feedback and approval.


• Develop cross functional relationships to support the strategy setting and execution.

Qualifications - what you need to perform the job

Education

• Required (minimum): bachelor's degree in a related field


• Preferred: MBA, or other master's degree with healthcare or financial focus

Experience

• Required (minimum): 10-15 years of professional experience


• Preferred: 5-10 years of health plan or provider experience, preferred


• Experience with Medicare, Medicaid and/or Dual product management, preferred

Skill Requirements

• Must possess maturity, and a high degree of professionalism.


• Exceptional oral and written communication skills, including for senior most audiences.


• Deep understanding of the managed care industry, health insurance product life cycle, and government healthcare.


• Self-starter, able to think creatively, take responsibility, and be extremely resourceful.


• Enjoys, and excels, executing in complex environments with significant amounts of uncertainty and ambiguity.


• Must be able to work collaboratively across a highly matrixed organization, and drive progress through influence.


• Proven ability to build relationships with external stakeholder groups, including regulators and advocates.


• Track record of developing and advancing junior team members and building high performing teams.


• Strong analytical skills, including financial management.


• Significant experience designing quantitative and qualitative data analyses and leveraging them for data-driven decisions.


• Familiarity with community-based care management models.


• Comfort working closely with internal and external clinicians.


• Strong project management and stakeholder management skills.


• Highly organized; able to effectively delegate to team members and escalate, as appropriate.


• Experience with applicable software and database programs including Excel, Word, PowerPoint.

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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