Teams at Point32Health

Review and manage pharmacy prior authorization requests and coverage determinations, consult with medical directors on complex cases, communicate with members and providers, perform medication management and reconciliation for complex patients, support utilization management policy interpretation, liaise across departments, and participate in quality, risk management, and care coordination activities.

Manage and support cross-functional program operations and vendor relationships. Perform policy and impact analyses, recommend process changes, support planning and implementation of projects, facilitate meetings, track deliverables, and resolve roadblocks to ensure program success.

Lead enterprise underwriting and pricing strategy for large and small group business. Develop rates, underwriting policies, tools, and stop-loss management; direct underwriting operations, analytics, vendor and sales support, and team leadership to balance market penetration and profitability while ensuring regulatory compliance.