Manager, Ancillary Provider Contracting

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 Manager of Allied Health Contracting oversees a team of Contract Managers, Associate Contract Managers, or other staff as appropriate who oversee negotiating with allied health providers. This individual may be the lead on managing certain allied contracts and will assist team members during negotiations by providing oversight and assistance with the negotiations of financial and legal terms. The Manager, Allied Health Contracting will work closely with the Director, Allied Health Contracting and Vice President as applicable on negotiation strategy development and execution. Additionally, this individual will work closely with contract management staff on the day-to-day negotiations and implementations to ensure smooth and timely transitions of key contract elements.

Job Description

Key Responsibilities/Duties – what you will be doing (top five):

• Supervise and support contract management team’s negotiations of contractual arrangements with established or potential network providers, within budgeted targets and regulatory requirements. Oversee and ensure accurate and complete analytic requests to support contract negotiations; oversee the development of contract documents. Participate as the lead in negotiations when appropriate and directly manage high cost, high volume contracts.
• Understand, with a high degree of specificity, important business aspects such as budget models, unit cost trend, and other analytics utilized by Point32Health to understand performance, financial or otherwise, of the allied provider network. Work closely with the contract management staff and legal department to ensure contract provisions are consistent across providers and ensure all applicable legal terms are included in the signed contract.
• Oversee the staff of Allied Health Contract Managers and Associate Contract Managers, providing coaching, feedback, and direction to allow team members to develop subject matter expertise and independently manage the ancillary service lines assigned to them
• Assist contract management staff and Director to develop Point32Health position on key issues relevant to the contract negotiation. Manage and position the negotiation so that Point32Health meets the key objectives that have been identified; communicate status of negotiations and document key financial and legal terms
• Lead and/or participate in cross functional meetings as required; lead internal ad hoc discussions to address contracting issues.
• Other duties and projects as assigned.

Qualifications – what you need to perform the job

Certification and Licensure

Education

• Required: Bachelor’s degree
• Preferred: Master’s degree

Experience

• Required: 5-7 years of professional experience
• Preferred: 8-10 years of experience in contract negotiations, including familiarity with payment methodologies.

Skill Requirements

• Contract negotiation experience is required, with ability to understand and interpret all aspects of a contract: financial, legal, and operational with emphasis on implementation of contract terms
• Demonstrated strength in finance to support financial contract components and analysis
• Ability to research, interpret and communicate complex issues
• Ability to understand the nuances of Tufts Health Plan’s commercial and Medicare Preferred product lines and the unique operational and financial features associated with each
• Ability to maintain effective and productive staff/management relationships, including the ability to motivate staff by fostering team spirit, an attitude of cooperation, and a commitment to the organization
• Ability to understand the nuances of Tuf