Program Manager II - Payment Integrity

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 The Program Manager II is responsible for projects and initiatives with significant cross-functional interface that support assigned programs and/or vendors. Responsibilities include managing major departmental programs with significant cross functional interface with moderate complexity, risk and/or cost. Responsibility may include development of new programs as well as management of ongoing programs. Changes to programs require some negotiation and change management skills to implement. By using knowledge of the company, the Program Manager II should be able to resolve most roadblocks to ensure success and progress. The Program Manager II should make recommendations for change by performing cost/benefit analysis and by using basic analytical and problem-solving capabilities to support the recommendation. Will also directly interact with internal and external leadership from both Point32Health and key clients and/or vendors. Job Description DUTIES/RESPONSIBILITIES - what you will be doing (top five): Manage ongoing assigned program operations and/or vendors. This may include working with multiple areas within the organization and directly with clients and/or vendors to ensure effective, accurate, timely processes and workflows. Use analytic skills to develop or improve programs including business opportunity definition and research. Perform detailed policy and impact analysis as it relates to the current programs, clients and/or vendors; make recommendations for process and/or policy change; present to various levels of the organization and the client the findings and summary options. This includes determining data scope, consulting with many Point32Helath staff, performing analyses, and determining both quantitative and qualitative business implications. Lead and/or manage projects and/or initiatives by representing program operations during planning and implementation phases. This may include support of other company programs and coordinating issue resolution with relevant functional business areas and leading and/or facilitating planning and review sessions. Lead regular cross functional informational or working meetings, including effective agenda planning, facilitation, and tracking/follow up on deliverables until closed. Other duties and projects as assigned. QUALIFICATIONS - what you need to perform the job Certification and Licensure Education Required: (minimum) bachelor's degree or equivalent work experience is required. Preferred: master's degree