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 SCO Care Management program has grown and will continue to grow, in membership, regulatory complexity, and operational scope, exceeding the capacity of existing clinical management structures. While Clinical Managers focus on frontline execution, there is no centralized accountability for program performance, regulatory readiness, audit response, and cross product alignment across SCO and D SNP programs.

A dedicated Program Performance Manager will serve as the single point of accountability for SCO Model of Care integrity, audit coordination, MDS HC/UCA quality oversight, performance reporting, and continuous improvement.

Under direction of the Director, manages programs and projects with significant complexity, risk and/or cost related to compliance and quality as well as manages 3 or more direct reports.

Initial key responsibilities will include:
Regulatory & Compliance Leadership

• Serve as the SCO Care Management regulatory and contract subject matter expert
• Own audit readiness and response for State, CMS, and internal monitoring
• Translate Model of Care and regulatory requirements into operational workflows, training, and documentation standards
• Ensure alignment of policies and procedures with evolving regulations (e.g., UCA, eCAS, CTD MHK)

Program Performance & Quality Oversight

• Own and monitor program level KPIs (Stars, HEDIS, utilization, transitions of care, MDS performance)
• Lead cross functional performance improvement initiatives
• Ensure Care Management readiness for new system launches and regulatory changes

Strategic Enablement & Sustainability

• Act as the primary liaison between Care Management, Product, Population Health, Compliance, and IT
• Maintain centralized governance for policies, training content, and regulatory guidance
• Ensure continuity and sustainability of improvements post implementation

Job Description

• Overall program ownership and management of key programs, focusing on both short-term initiatives and long-term strategic direction and objectives for the programs.
• Development, implementation, and oversight of the Program including but not limited to
  • leading interpretation and implementation of new regulatory guidance and prepare,
  • providing consultation to staff on compliance issues and processes and
  • coordinating responses for all internal and external activities across LOBs.
• Oversees all activities and responsibilities of the quality team including but not limited to
  • Manages the design/development, implementation, evaluation, and report writing of quality improvement programs and projects
  • Collaborates with business partners to conduct secondary research and to design and implement qualitative and quantitative analysis as needed. Formulates findings, draws conclusions, makes recommendations for action and works with stakeholders to document the findings and reports based on the data.
  • Responsible for the timely completion of all activities and final deliverables that meet requirements for the QI programs.

• Leads the major Program for the department and organization including collaborating with colleagues across the organization, participating as a member of organization Parity Core team, leading the implementation of organization wide parity champion program.
• Leads regular cross functional informational or working meetings, including effective agenda planning, facilitation, and tracking/follow up on deliverables until closed. Meetings include, but not limited to, Business Stakeholders and Operations Working team.
• Other duties and projects as assigned.

EDUCATION, CERTIFICATION AND LICENSURE:

• Bachelor’s Degree required
• Master’s degree preferred
• PMP Certification preferred. PMP eligibility required.

EXPERIENCE (minimum years required):

• 8-10 years' business or industry experience.
• 5-8 years of program management experience, including leading significant cross-functional, high-level initiatives.

SKILL REQUIREMENTS:

• Using knowledge of company, able to resolve most roadblocks to program progress. Able to operate in a matrixed environment. May need to coordinate the participation of other internal contacts to develop and or maintain programs.
• Able to navigate political issues using advanced organizational knowledge. Is an effective advocate for program, and negotiates/leads others both internally and externally to participate in the program. May be required to coach/mentor less experienced program managers and effectively lead in a matrixed environment.
• Proactively identifies conflict/integration issues and leads team members to parse/synthesize issues of the highest complexity. Able to identify risk out of the larger picture and has a proven ability to accurately estimate and plan resource usage. Able to identify and make decisions that serve the best interests of Point32Health.
• Detailed content knowledge of the specific program. Must be able to converse and lead dialogue on the subject with minimal direction; advanced training in the field related to the program is preferred.
• Ability to thrive in a matrix-management, hands-on environment that demands a consultative approach and solutions that span multiple environments in a business area.
• Outstanding communication and relationship management skills required, including the ability to effectively manage difficult group dynamics to effectively reach a positive outcome.
• Excellent human resource management skills, ability to oversee team of program managers as part of the overall program.
• Highly developed oral and written communication skills, ability to communicate with and influence internal and external constituents at all levels with confidence.
• Highest level presentation skills including ability to interface and “sell” new programs and changes to existing programs to a broad range of internal and external contacts, as necessary. Ability to interact with confidence with external and senior management.
• Strong negotiating, influencing, and advocacy skills, ability to lead others both internally and externally to ensure the success of the program.
• Ability to navigate political issues using advanced organizational knowledge.
• Must be flexible and a proponent/champion of change, able to conceptualize and envision the impact of change, and propose new ways to do business.
• Must be an accomplished multi-disciplinary team-leader and team-builder with hands-on style. Ability to lead teams whose members have diverse professional and educational backgrounds, and to effectively manage difficult group dynamics to effectively reach a positive outcome.
• Ability to present technical information in a way that establishes rapport, persuades others, and gains understanding.
• Highly developed verbal and written skills, ability to facilitate planning and review sessions with senior mgmt., high level presentation skills including ability to interface and “sell” new programs and changes to existing programs to a broad range of internal and external contacts, as necessary.
• Requires the ability to maintain effective and productive peer relationships. Must have the ability to motivate fellow employees by fostering team spirit, an attitude of cooperation, and a commitment to the organization. Requires well-developed interpersonal skills to act in the capacity of liaison to the user community.
• Possess strong influencing skills with the ability to manage and motivate both direct and non-direct reports. Must have a demonstrated ability to obtain the confidence and trust of non-reports, resulting in high commitment and cooperation.

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

$121,943.34 -$182,915.00

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 TA_operations@point32health.org