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

Job Description

Key Responsibilities/Duties – what you will be doing (top five):

• Lead the negotiation of contractual arrangements with established or potential network providers, within budgeted targets, administrative requirements, and regulatory requirements. Direct financial analyses to support contract negotiations, independently develop proposals oversee the development of contract documents, and compose comprehensive contracts inclusive of contractual conditions, legal terms, and financial elements, for successful implementation.
• Work closely with the legal department to ensure contract provisions are consistent across providers and ensure all applicable legal terms are included in the signed contract. Understand organizational, state-level, and national laws and regulations to ensure contract language meets compliance standards.
• Articulate to Network providers, including individuals at the executive level, Point32Health’s position on key issues relevant to the contract negotiation. Senior Contract manager to be well versed in publicly reported financial data such as provider relative price, total medical expense, and hospital 403 cost information for use in negotiations. Senior CMs also responsible for negotiating terms of multiple risk arrangements across all products and clearly defining those terms. Senior CMs work closely with partner departments (clinical, reporting, quality) to develop key objectives for the contract cycle. Manage and position the negotiation so that Point32Health meets the key objectives that have been identified for the contracting cycle.
• Understand, with a high degree of specificity, important business aspects such as global budget models across all products, unit cost trend, provider financial performance, and any analytical tools utilized the Point32Health to understand the performance, financial and otherwise, of the provider network.
• Lead and/or participate in cross functional meetings throughout the organization; lead internal ad hoc groups to address contracting issues, communicate status of negotiations and document key financial and legal terms.
• At manager’s discretion, maintain ownership and the development of at least one key negotiation tool or support function (sales, government affairs etc.)
• Primary relationship contacts with provider organization during negotiation
• Other duties and projects as assigned.

Qualifications – what you need to perform the job

Certification and Licensure

Education

• Required: Bachelor’s Degree
• Preferred: Master’s Degree

Experience

• Required: 5-7 years in managed healthcare. Experience in contract negotiations preferred, including familiarity with various payment methodologies.
• Preferred: 8-10 years of related work experience

Skill Requirements

• Excellent communication skills, both oral and written.
• Established presentation and influencing skills
• Demonstrated strength in finance to support financial contract components and analysis
• Ability to independently research, interpret, communicate, and resolve complex issues
• Advanced analytic ability with proficiency in Microsoft Word, Excel, and PowerPoint applications
• Excellent time management skills to manage multiple priorities to deadline

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

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 [email protected]