Program Manager II - Payment Integrity

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

The Program Manager II is responsible for projects and initiatives with significant cross-functional interface that support assigned programs and/or vendors. Responsibilities include managing major departmental programs with significant cross functional interface with moderate complexity, risk and/or cost. Responsibility may include development of new programs as well as management of ongoing programs. Changes to programs require some negotiation and change management skills to implement. By using knowledge of the company, the Program Manager II should be able to resolve most roadblocks to ensure success and progress. The Program Manager II should make recommendations for change by performing cost/benefit analysis and by using basic analytical and problem-solving capabilities to support the recommendation. Will also directly interact with internal and external leadership from both Point32Health and key clients and/or vendors.

Job Description

DUTIES/RESPONSIBILITIES – what you will be doing (top five):

• Manage ongoing assigned program operations and/or vendors. This may include working with multiple areas within the organization and directly with clients and/or vendors to ensure effective, accurate, timely processes and workflows. Use analytic skills to develop or improve programs including business opportunity definition and research.
• Perform detailed policy and impact analysis as it relates to the current programs, clients and/or vendors; make recommendations for process and/or policy change; present to various levels of the organization and the client the findings and summary options. This includes determining data scope, consulting with many Point32Helath staff, performing analyses, and determining both quantitative and qualitative business implications.
• Lead and/or manage projects and/or initiatives by representing program operations during planning and implementation phases. This may include support of other company programs and coordinating issue resolution with relevant functional business areas and leading and/or facilitating planning and review sessions.
• Lead regular cross functional informational or working meetings, including effective agenda planning, facilitation, and tracking/follow up on deliverables until closed.
• Other duties and projects as assigned.

QUALIFICATIONS – what you need to perform the job

Certification and Licensure

Education

• Required: (minimum) bachelor’s degree or equivalent work experience is required.
• Preferred: master’s degree

Experience

• Required: (minimum) 3-5 years of professional experience
• Preferred: 3-5 years of health plan experience with 6-8 years working experience. Program management or equivalent experience leading significant department level initiatives

Skill Requirements

• Excellent verbal and written communication skills generally acquired through college or other advanced education is required
• Well-developed verbal and written skills, ability to facilitate planning and review sessions.
• High level presentation skills including ability to interface effectively with external contacts and/or clients
• Ability to exercise sound judgment and raise issues to appropriate team members or management for resolution
• Ability to conceptualize the impact of change and propose new methods of conducting business
• Ability to use analytical skills to develop new or implement change to existing program functions
• Ability to interpret and explain the implications of planned changes to current state business units
• Ability to problem solve and overcome obstacles to ensure successful program operations

Technical skills:

• Proficiency with MS Office applications (Word, Excel, PowerPoint)
• Ability to utilize multiple applications simultaneously

Interpersonal skills

• Requires the ability to work cooperatively as part of a team.
• Must be able to effectively communicate with all internal departments in verbal and written formats.
• Requires some presentation experience
• Must be able to work in a matrix environment with minimal supervision

Security Clearance (if applicable):

• The position may require a background investigation and fingerprint form on file with the US Office of Personnel Management. Questionnaire For Public Trust Position (standard form 85P) must be completed and approved.
• Access to several secure government websites may be needed.

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

$77,267.86 -$115,901.80

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]