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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

Under the administrative direction of the Director of Care Management Strategy and Clinical Programs, the Senior Manager of the Advanced Clinical Care Program is responsible for supporting the Advanced Clinical Care team and the defined functions central to the program that support essential business and organizational objectives. This includes program oversight, direction and execution on clinical care model functions that aim to improve member outreach and the successful execution of comprehensive evidence based clinical programs that improve quality and outcomes while simultaneously lowering costs.

The Senior Manager of the Advanced Clinical Care team will accomplish this by collaborating with the clinical leadership team and participate in both strategic and day-to-day activities that help to ensure program success and is directly responsible for the business performance of the program. This would involve developing workflows and standardized processes to address high costs and advanced illness management in the geriatric population with the help of available data to assess the effectiveness of these interventions. The Senior Manager is also responsible for collaborating with the data/analytic team to ensure appropriate monitoring and oversight of intervention and the delivery of defined metrics to validate business unit/program effectiveness. The Senior Manager may be asked to act as a clinical consultant to the various members of the internal care team as well as the clinical leadership of internally managed medical groups/IDN’s on individual cases.

The Senior Manager of the Advanced Clinical Care team works collaboratively with other members of the Senior Products Care Management (SP CM) Leadership team, SP Internal and External Medical Directors/Clinical Leadership and other appropriate Point 32 Health staff to identify and address opportunities to manage utilization, improve quality, identify gaps in knowledge or services, reduce administrative cost and demonstrate outcomes for clinical, financial and utilization functions and programs within jurisdiction.

Key Responsibilities/Duties – what you will be doing

Business Process Implementation and Oversight

• Accountable for the development and implementation of advanced level programs that support overall business initiatives and align with organizational vision and mission. This includes but is not limited to:

• Partners with the Director of Care Management Strategy and Clinical Programs to create an annual department business plan for future direction of the department. Solicits input and generates consensus on that plan across RAO, CM, UM, Quality, and others stakeholder departments.

• Actively participates, develops and refines the SCO MOC process that includes the assessment of the model in improving health outcomes within a designated population in which the advanced clinical care team is identified as having an impact

• Directly responsible for the successful integration and execution of existing and future clinical Geriatric programs to support the care needs and regulatory requirements of a designated high-risk population

• Collaborates with Senior Manager of the SP Integrated Care Management model to support a standardized member experience across the network. In addition, ensures programs, initiatives, and interventions support MOC, evaluating effectiveness of clinical/care interventions

• Continuously evaluates the effectiveness of new and existing program objectives to meet business initiatives and executes on those changes that are determined to be needed. Develops and monitors KPIs including productivity data of NP staff, CHA completion and CHA program ROI, SNF program outcomes including LOS and readmission rate, and others.

• Provides clinical and operational oversight and direction to assigned team

• Bridges advanced clinical care team efforts across matrixed organization to support innovative thinking and approaches as it relates to complex member care management with a goal to improve outcomes

• Ensures all programs support the clinical, regulatory, and business goals of the department

• Active participant in population health strategies

• Act as a clinical consultant to department staff on member level and provider performance functions for Senior Products

• Accountable for recruitment, evaluation, management and development of clinical and administrative staff and other applicable staff within jurisdiction.

• Collaborates with all members of the CM leadership team and acts as a resource to multi-disciplinary team members providing support to both HMO/SCO members.

• Responsible for monitoring/managing performance related to execution of clinical programs/initiatives

• Actively and continuously assesses current business processes and evaluates opportunities for business efficiencies and growth

• Communicates and collaborates with department and other key stakeholders to develop and implement strategies to optimize the efficacy and cost efficiency of the preferred networks, as well as identifying critical clinical performance metrics to align contract incentives

• In collaboration with the SP Clinical Leadership team, facilitates the development and implementation of performance targets, quality, cost, utilization, outcome measures and reporting for functions within business unit, providing specific insights on complex member management

• Provides input to content development and revision of policies/procedures and workflows pertaining to SP Care Management activities, internal workflows, and performance metrics

• Consults and collaborates with subject matter experts regarding specific business line regulatory and compliance requirements

• Represents the Advanced Clinical Care team in key cross functional committees, business performance, quality, and regulatory forums

• Participates as a SME and functional owner in Business Performance meetings and product performance with SP leadership

Staff Development

• Directly responsible for monitoring performance of assigned teams; identifies performance concerns as they appear; works with clinical and provider performance team to address clinical/medical management performance concerns; continues to escalate performance concerns until a corrective course results in improvement.

• Provides expert clinical consultation and education for staff and other providers in support of program expectations and other regulatory requirements and business initiatives

• Actively participates in development and oversight of clinical content for orientation and ongoing training. Oversees the execution of the orientation, training, and staff development process for identified teams with the goal of enhancing the professional development of staff

• Serve as clinical consultant and resource for complex/escalated situations

• Responsible for the development, execution and oversight of standardized processes and workflows to support clinical programs

• In collaboration with cross functional interdisciplinary team, leads the development and direction of a training plan to support clinical initiatives and competencies

• All other line management functions for all NPs and administrative staff in the department, including but not limited to:

• creates and modifies staffing plan, hiring, coaching, salaries, bonus decisions, performance management, and tracking training, including CME and company mandated training

Clinical Responsibilities

• Conducts and participates in CHA program as time and geography allows

• Supports clinical rounding program that includes managing a patient census with regular clinical responsibilities as well as weekly rounds for designated population as assignment, contract requirements and time allows – this is subject to change based on the program needs and geographies which may result in shifting role to include more administrative focus and responsibilities

• Participates in evening and weekend on-call schedule, as required

Resource Management

• Supports the planning, budgeting, and oversight of department resources in partnership with the Director of Care Management Strategy and Clinical Programs

• Accountable for realization of department administrative budget targets

Corporate Participation

• Represents Advanced Clinical care team in relevant corporate teams as required

• Implements and supports fulfillment of corporate objectives within jurisdiction

• Other projects and duties as assigned

Qualifications – what you need to perform the job

Education, Certification and Licensure

• Licensed Nurse Practitioner in the Commonwealth of Massachusetts

• Master’s degree in Nursing (MSN) or Doctor of Nursing Practice (DNP) is required

Experience (minimum years required) :

• 8-10 years’ experience in managing Geriatric/chronic illness populations and/or direct care of inpatient/ambulatory geriatric/chronically ill population.

• 5 years’ management experience preferred

• Experience in managed care systems and operations is highly desirable.

• Expertise in business process changes and leading people is also desirable.

Skill Requirements

• Formidable understanding of Medicare regulations is essential

• Familiar with foundational case management concepts, challenges, and criteria

• Work cooperatively as a team member across multiple levels within the organization

• Consultative skills with all members of the care team with strong member engagement skills

• Results orientation with a focus to meet business goals

• People Management

• Proficiencies with Excel/Microsoft office

• Critical and Analytic thinking – must understand cause and effect, internal and external impact of business changes

• Strong communications skills (formal and informal, written and verbal)

• Coaching and Mentoring - primarily of reports, but also of others

• Must have commitment to excellence in customer service

• Regard for confidential data and adherence to corporate compliance policy

• Ability to handle multiple demands and balance multiple priorities

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel) :

• Travel required on an as needed basis

• Occasional evening, weekend, early morning, or extended day work may be required

• Must be able to travel between two or more corporate sites as required.

• 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.

We encourage all Point32Health colleagues to follow CDC guidance about COVID-19 vaccines, boosters, isolation and masking. Point32Health reserves the right to adjust its requirements in response to COVID-19 trends in the communities we serve.

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.