Teams at Point32Health

Leads negotiations with large physician and hospital organizations, managing financial, legal, regulatory, quality, and risk-sharing contract terms. Develops proposals, directs financial analyses, oversees contract documents, and partners with legal, clinical, reporting, and quality teams. Maintains provider relationships, communicates negotiation objectives to executives, ensures compliance with contracting strategy, and leads cross-functional efforts addressing contracting issues and negotiation tools.

Supports enterprise and market strategy development by analyzing healthcare industry trends, competitive dynamics, legislation, customer needs, and financial implications. Coordinates strategic planning initiatives, prioritizes projects, develops growth targets and value propositions, supports scenario planning, and tracks initiative effectiveness. Collaborates with executives, business leaders, subject matter experts, vendors, and external stakeholders to identify opportunities, resolve strategic issues, and communicate recommendations across the organization.

Reviews clinically complex outpatient service requests for medical necessity and benefit coverage within regulatory timelines. Performs utilization management determinations, collaborates with Medical Directors on denials, communicates with providers and members, supports appeals, coaches letter writers, identifies utilization trends, and contributes to medical policy and process improvements. The role requires independent judgment, clinical expertise, and knowledge of managed care operations.