Job Information
Point32Health Manager, Provider Account Management - Behavioral Health in Canton, Massachusetts
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. To learn more about who we are at Point32Health, click here (https://youtu.be/S5I_HgoecJQ) .
Job Summary
This leader is responsible for cultivating, maintaining and strengthening relationships with our network of behavioral health providers and trade associations, in all geographic areas where we do business. Additionally, this person helps shapes strategy and policies relevant to our behavioral health provider network. While working across the business, this individual will create positive working relationships with providers, resolving provider inquiries and navigating the nuances of our markets, including regulatory requirements. This position requires a proactive self-starter with independent initiative and strong skills to strategically lead the behavioral health provider account management team.
The Provider Account Management Manager will manage a staff who are liaisons internally between departments within Point32Health and externally with providers. Working in a heavily matrixed environment, the Manager of Provider Account Management (or Manager of Provider Relations) must possess flexibility, management skills, leadership skills, ability to think and act strategically, independent initiative and excellent communications skills.
Key Responsibilities/Duties – what you will be doing
DUTIES/RESPONSIBILITIES – what you will be doing:
Strategically manage and successfully lead Enterprise Behavioral Health Provider Account Management Team to ensure operational issues are well managed and do not get escalated and/or interfere with negotiations with our Contracting team.
Manage and coordinate the resources, responsibilities, processes, and workflows to ensure quality and timely account management support. Revise policies, processes, manuals, and documentation to maintain compliance and clinical best practices.
Monitor the overall progress of team initiatives and provide status updates to leadership, managers and representatives of partner departments such as Behavioral Health, Network Contracting, Medical Policy, Servicing, Product Strategy, Claims, Legal, Pharmacy, and Care Management.
Own and drive strategic and operational priorities for the provider, leading and bringing in support from internal corporate departments as necessary.
Strategically lead successful implementation of new accounts/partnerships by identifying most appropriate/suitable provider account management needs and ensuring that the provider needs are met.
Develop and report on KPIs, relationship metrics and measurements to ensure provider relationship as being appropriately managed. Analyze, synthesize, and interpret trends and data to identify opportunities for process improvement for both client and operations team.
Represent the provider voice and Point32Health voice in stakeholder meetings as well as in meetings related to medical cost management/vendor programs.
and collaborate cross-functionally to ensure that provider needs are met and that escalated issues are resolved.
Lead key provider and Point32Health internal meetings required to execute on strategies, including the development of agenda, materials, preparation and facilitation.
Other duties and projects as assigned.
Qualifications – what you need to perform the job
QUALIFICATIONS – what you need to perform the job
EDUCATION, CERTIFICATION AND LICENSURE:
Bachelor’s Degree in business or healthcare management; Master’s Degree preferred.
Knowledge of health care insurance industry is a must (experience in behavioral health is preferred).
EXPERIENCE (minimum years required) :
Minimum 10+ years of experience in a health care environment with a proven track record of establishing, building, and managing accounts.
Management experience as well as program management experience, including leading cross functional initiatives and project management is necessary.
Experience in behavioral health preferred.
SKILL REQUIREMENTS:
Experience in the health insurance field specifically with contracting, provider reimbursement, and claims concepts is needed. Experience with Commercial, Medicaid, and Medicare reimbursement methodologies is preferred
Excellent communication and interpersonal skills, including presentation, verbal and written skills
Ability to be a team leader and a team player, managing group dynamics to effectively reach a positive outcome
Ability to understand strategic objectives and develop operational processes to support these objectives
Ability to connect the big picture with the operational details
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.
#LI-RL1
#LI-Hybrid
Compensation & Total Rewards Overview
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/
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.
At Point32Health, we strive to be a different kind of nonprofit health and well-being company, with a broad range of health plans, and innovative tools that make navigating health and well-being easier, guiding our members at every step of their health care journey to better health outcomes. We are committed to providing high-quality and affordable health care, improving the health and wellness of our members, and creating healthier communities across the country. The Point32Health name is inspired by the 32 points on a compass. It speaks to the critical role we play in guiding and empowering the people we serve to achieve healthier lives. Our employees are hard-working, innovative, and collaborative. They look for opportunities to grow and make a difference, and they help make us strive to be one of the Top Places to work in New England.