Senior Manager, Provider Performance

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 Senior Manager of Provider Performance leads the PPM Team in the development and execution of strategies aimed at optimizing the performance of our clinical provider network. The role plays a crucial role in achieving the highest standards of patient care and provider performance. Additionally, this role has oversight of Tufts Medicare Preferred Externally Managed relationships (Care Management and Utilization Management)

Job Description

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

• Lead the management of clinical provider performance, including communication, performance evaluation, and issue resolution.
• Define, track, and report on key performance indicators (KPIs) to assess the effectiveness and quality of clinical providers.
• Collaborate with clinical providers to identify areas for improvement and develop performance improvement plans.
• Utilize data analysis and reporting to provide insights into provider performance and contribute to data-driven decision-making.
• Implement and oversee quality control measures to ensure the highest level of patient care and compliance with standards.
• Develop and maintain strong relationships with clinical providers, addressing inquiries, concerns, and promoting best practices.
• Work with the leadership team to create and execute strategies that enhance the overall performance of the clinical provider network.
• Manage a team of performance specialists, providing coaching and support to enhance their skills and performance.

• Other projects and duties as assigned.

Qualifications – what you need to perform the job

Certification and Licensure

• None Specified

Education

• Required (minimum): Bachelor's degree in Healthcare Administration, Business, or a related field
• Preferred: Master's degree
• Required (minimum): 8-10 years of professional experience.
• Preferred: 8-10 years of experience in clinical provider performance management, quality improvement, or a related role with a successful track record in leadership

Experience

• Required (minimum): 8-10 years of professional experience.
• Preferred: 8-10 years of experience in clinical provider performance management, quality improvement, or a related role with a successful track record in leadership.

Skill Requirements

• Strong analytical and problem-solving skills.
• Proficiency in healthcare data analysis, performance metrics, and quality assurance.
• Excellent communication and interpersonal skills.
• Proven ability to lead and manage a team effectively.
• Strategic thinking and the ability to drive process improvements.

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.

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

$114,322.40 -$171,483.60

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]