Director, Network & Provider Analytics

About the role

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 Reporting to the Vice President of Network and Provider Performance Management, the Director of Network and Provider Analytics plays a strategic leadership role with the Provider Partnerships organization. The Director manages a team of managers and analysts, working in a matrix environment to support and collaborate with colleagues from System Contracting, Ancillary Contracting, Actuarial, Sales and Provider Performance. He/she oversees the development and timely delivery of relevant and meaningful financial analyses in support of Point32Health's provider contracts and network performance for all commercial and government payor lines of business. Job Description DUTIES/RESPONSIBILITIES - what you will be doing (top five): Proactively identify and oversee the development of analyses, models, and tools to offer an informed view of provider, network, and contract performance In collaboration with System and Ancillary Contracting leadership, formulate and execute on strategies to improve unit cost, standardize reimbursement methodologies, and maintain competitive provider networks Provide direction and define approach and parameters for overall reimbursement strategy and payment methodologies, with the goal of standardization, optimization, and transparency. Oversee development of provider rates in line with negotiated terms Oversee the submission of regulatory submissions and requests Monitor, analyze and report on competitive position for all applicable Point32Health markets Produce accurate and timely reporting on network access and adequacy, ensuring standards are maintained and gaps are appropriately addressed Engage with Sales team to provide compelling information and reporting in support of employer account engagement, actively participating as a subject matter expert in cross-departmental as well as external provider and broker meetings. Actively represent the Provider Partnerships organization in Corporate Data & Analytics, Finance, Actuarial, Trend, Health Care Services, Information Technology, and other department and enterprise governance forums. Provide thought leadership, express business needs, and manage relationships with key internal constituencies Accountable for ensuring the team adheres to enterprise data and analytics governance standards, policies, and procedures Recruit, retain and develop talent. Coach and support staff in analytics, leadership and relationship management to enable a high-performing team Other duties and projects as assigned QUALIFICATIONS - what you need to perform the job Certification and Licensure Education Required (minimum): Bachelor's degree in business, health administration, finance, or a related field Preferred: Master's degree preferred, or relevant experience