Manage clinical pharmacy operations, lead a team executing pharmacy programs, ensure compliance with regulations, and drive cost-efficiency initiatives.

The Investigator I conducts investigations related to fraud, waste, and abuse, focusing on prepayment claims and developing strategies to prevent future issues.

The Investigator I conducts prepayment fraud investigations, develops action plans, and collaborates with teams to address FWA-related issues in healthcare.

The Appeals and Grievance Analyst manages member appeals and grievances while ensuring compliance with regulations and providing excellent customer service. Responsibilities include documentation, investigation, and resolution of cases.

The Administrative/Project Specialist provides organizational support to faculty and team members, manages calendars, handles communications, and assists with grant submissions, meetings, and special projects.

This role involves developing and executing strategic initiatives within Point32Health, focusing on product strategy, market evaluation, and cross-functional collaboration to promote Commercial growth.

The Director oversees sales, operations, and member engagement for Individual Markets, ensuring performance against targets and developing growth strategies. They manage partnerships, compliance, and team performance, while fostering stakeholder relationships and driving operational integration across multiple states.

Lead a team to analyze and improve Point32Health's information security environment, developing measures for data confidentiality, integrity, and availability. Collaborate with IT and business organizations to ensure security compliance and communicate security concerns to leadership.

The Senior Network Performance Analyst will analyze healthcare provider contracts, lead cost-saving initiatives, and generate actionable financial analytics.

The Manager oversees contract negotiations with allied health providers, leads a team of contract managers, and ensures smooth contract transitions while meeting financial and legal objectives.

The Research Assistant supports a project on biosimilar drug use, conducting literature searches, reviewing patents, coordinating data collection, and assisting the project team with various tasks.

The Fraud Operations Specialist develops relationships, delivers anti-fraud training, ensures compliance, and leads investigations related to fraud, waste, and abuse.

The Appeals and Grievances Analyst manages member appeal and grievance cases, ensuring compliance with regulations and providing superior customer service during the process.

The Appeals and Grievance Analyst manages member appeals and grievances, ensuring compliance with regulations while providing excellent customer service and benefit interpretation.

The Manager will lead the Risk Adjustment Operations & Provider Consulting team, focusing on program management, provider engagement, and risk adjustment strategies for healthcare services. Responsibilities include analyzing risk score data, managing vendor contracts, leading strategic planning efforts, and developing financial reporting for various health plan products.

Lead the design and delivery of digital solutions for healthcare experiences. Oversee product lifecycle, stakeholder engagement, and team development while enhancing user experiences on digital platforms.

The Director of Network Contracting leads contract strategy and negotiation for provider networks, focusing on membership growth and quality performance. This role manages a team and collaborates across multiple divisions, ensuring effective relationships with strategic providers and compliance with regulations.

The Manager of Product Strategy for D-SNPs drives strategic initiatives for growth and compliance, collaborates cross-functionally, and evaluates product performance to enhance member experience.

The Clinical Pharmacist manages and reviews pharmacy prior authorization requests, ensures compliance with regulations, and communicates with members and providers.