Vice President, Network Strategy & Operations

Who We Are Point
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Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point
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Health 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 Point
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Health .

Job Summary The Vice President, Network Strategy & Operations is responsible for leading the execution of network-related functions underpinning the enablement of contracts supporting all lines of business. This leader will devise strategy for standardizing, streamlining, digitizing, and optimizing enabling functions that comprise the end-to-end provider experience. The scope of responsibilities include provider contracting operations/updates, and provider enrollment and credentialing. To be successful, the VP, Network Strategy & Operations will have awareness of cross enterprise dependencies and will collaborate cross functionally with various functions within each Point
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Health line of business. This role requires innovative thought leadership and will be key to modernizing Point
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Health’s interface with its provider network(s) with both local and national partners. This modernization includes process scrutiny, optimization and transparency, and digitization of rote processes. The role also requires innovation related to the operating model for engaging providers broadly, and specifically in getting provider partners to collaborate with the plan in pursuit of modernization of co-dependent processes (e.g. enrollment, credentialing, roster integrity, provider data integrity).

Job Description DUTIES/RESPONSIBILITIES – what you will be doing:

Lead the Network Operations Function. In collaboration with LOB and SLT leadership, overlay an operating model that reflects the integrated entities’ strategic targets

Oversee contract implementation, ensuring all key terms are correctly configured in claims administrative platforms

Ensure continual innovation and improvement on implementation processes: seize opportunities to reduce steps, redundancy, and to produce ‘single process” across LOBsEnsure excellence within the Provider Operations (provider enrollment & credentialing)
In collaboration with lines of business (LOB), oversee the strategic development and implementation of provider network strategy and integrity

Other duties and projects as assigned.

QUALIFICATIONS – what you need to perform the job Certification and Licensure Education Required  (minimum):
Bachelor’s degree

Preferred:
Master’s degree

Experience

Required (minimum):

Minimum 10 years of professional experience.
5 years health plan experience required

Subject matter expertise in network operations, provider data issues, and health plan operations broadly

Experience influencing and building strong working relationships internally with key stakeholders and external with providers

Preferred:

SKILL REQUIREMENTS:

Excellent leadership skills to guide, inspire and develop a high performing team of professionals

Committed to empowering and developing talent through…