Medicare Manager Job at Point32Health
Who We Are
Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.
We enjoy the important work we do every day in service to our members, partners, colleagues and communities.
Job Summary
Working closely with CarePartner’s leadership, the Senior Manager is responsible for supporting business performance management processes, reporting and analysis for CarePartners of Connecticut. The Senior Manager will work with leadership to develop and manage an organization wide business performance program to measure performance, identify trends and utilize insights to help drive growth, earnings, and quality improvement. This is a highly visible role, working with business leaders across the organization in Actuarial, Operations, Clinical Services, Network Management, Legal, Compliance, Finance, Product Strategy and Sales.
Key Responsibilities/Duties – what you will be doing
- Develop and manage framework for business performance program to drive growth and improve CarePartners of Connecticut performance
- Collaborate with business leaders including sales, marketing, care management, risk adjustment, network management, and operations to identify and operationalize key performance indicators and outcome measures in their respective functional areas
- Identify, assess, and prioritize interventions to meet targets for medical loss ratio and operating margins
- Manage relationship with analytic resources, both internally and externally, to establish a reporting structure for continuous identification of business performance improvement opportunities
- Implement tracking and monitoring of efficacy of all interventions and business performance improvement programs
- Lead steering committees and facilitate cross-functional workgroups in support of business performance initiatives
- Working closely with Medicare line of business leadership, identify agenda, develop content and coordinate presentations for CarePartners of Connecticut Board Meetings
- Develop business cases for key initiatives in support of the business performance program
Qualifications – what you need to perform the job
Education, Certification and Licensure
- Bachelor’s degree in business, health care or related field.
- MBA strongly preferred
Experience (minimum years required):
- 7-10 years of experience in healthcare management, administration, or consulting
- In-depth understanding of health insurance economics and performance drivers
Skill Requirements
- Knowledge of managed care processes and operations
- Strong relationship building and leadership skills to influence and work collaboratively across functions and all levels of the organization including executive level.
- Strategic thinking skills: ability to draw meaningful insights and identify business implications
- Strong analytic skills: ability to synthesize and organize information for meaningful use and action
- Well-developed presentation and communication skills
- Energetic and proactive individual who strikes the right balance between self- initiation and collaborating with others.
- Demonstrated ability to master new content quickly
- Project management experience in managing large, complex projects and cross-functional initiatives
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.
#LI-hybrid
#LI-KR1
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.
Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity
Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who 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.
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