Vice President, Medical Management

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

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Job Summary

The Vice President of Medical Management, reporting to the Senior Vice President, Health Care Services is responsible for leading and transforming the medical management of in-patient, ambulatory and post-acute settings. This leader analyzes market trends and dynamics to identify opportunities and is responsible for developing and executing a multi-year strategy that aligns with the company's vision and goals. This position is accountable for evaluating internal operations against standard KPI designed to improve overall access to care, lower the total cost of care, and ensure high quality in compliance with all state and regulatory requirements.
This role will be responsible for fiscal and administrative oversight of a large internal team focused on industry standard productivity measures while consistently delivering high inter-relator reliability. This leader is also responsible for developing clinical platform strategy to meet the current and prospective regulatory requirements for automation and inter-operability.

Job Description

Key Responsibilities Include:

• Provide leadership and mentoring to the medical management team, fostering a culture of innovation and continuous improvement.

• Oversee and lead the design, implementation and delivery of key strategies aimed at ensuring consistent, efficient, and impactful UM programs

• Develop comprehensive strategy to position Point32Health as a leader in utilization management and effectiveness, including pre-service, concurrent post-service reviews and transitions of care.

• Lead ROI strategic UM initiatives, including business case development, implementation and monitoring of medical and administrative cost savings strategies to support evidence-based trend management in conjunction with outcome driven KPI’s

• Ensure departmental compliance with all regulatory and accreditation agency standards for state and federal requirements. Work in collaboration with IT to develop future capabilities with respect to PA automation and interoperability.

• Identify system needs, and improve internal efficiencies

• Collaborate with compliance to ensure consistent internal auditing for all regulatory processes, lead all corrective actions stemming from an audit.

• Identify key utilization trends that could impact the organization's financial and/or operational performance

• Ensure routine assessment of all metrics measured support internal and external factors that could affect performance

• Provide leadership and mentorship to the medical management team, fostering a culture of innovation and continuous improvement.

• Collaborate with stakeholders throughout the organization to identify opportunities and develop strategic partnerships

• Manage UM departmental budget, identifying ongoing opportunities to drive administrative efficiencies through automation and workflow redesign

• Other projects and duties as assigned.

Background & Experience

Education, Certification and Licensure:

• Advanced degree in related field required. Active clinical licensure preferred but not required

Experience (minimum years required):

• 10-15 years of progressive business and leadership experience in health care and/or managed care.

• 10+ years of leadership experience, supervising high-level professionals required, with demonstrated success in program development and execution

• Experience in leading and transforming the medical management of in-patient, ambulatory and post-acute settings

• Demonstrated success with design and execution of clinical system strategy and automation functionality

Skill Requirements:

• Experience in leading and transforming the medical management of in-patient, ambulatory and post-acute settings

• Ability to plan and act strategically

• Skilled in taking calculated risks

• Excellent quantitative skills and strong analytic background preferred

• Must possess strong leadership skills with proven ability to achieve goals and deliver bottom line results

• Proven ability to coach, motivate, and inspire staff

• Excellent communication, presentation, and negotiation skills, as well as organizational, analytical, and critical thinking skills

• Ability to work cross-functionally, supporting multiple, simultaneous objectives

• Ability to build internal programs including detailed workflows and corresponding key performance indicators and metrics

• Superb customer service focus; ability to foster teamwork as an attitude and a skill; willingness to be a change agent

Leadership Profile

Establishing a Competitive and Compelling Vision: Orchestrates a competitive and compelling mission with an aligned set of values, goals, and a winning strategic path. This vision ensures a forward-looking aspirational framework that guides current and future decisions and choices for an entire enterprise or business unit.

Managing an Effective and Agile Plan Execution: Establishes, manages, and monitors the operational tactical annual plan to effectively accomplish the mission, vision, values, and strategy.

Creating and Cultivating Culture: Formulates, communicates, and lives the culture and tone of the organization through highlighting mission and strategy aligned citizenship behaviors, standards, and norms.

Optimizing Structure and Staffing: Attracts and selects staff and structures units, roles, and responsibilities; deploys aligned staff whose capabilities enable the organization to achieve its goals. Approaches decisions on talent utilization with both a tactical and strategic orientation.

Marshalling and Optimizing Resources: Obtains and distributes all the hard and soft resources aligned to priorities, goals, and strategy; deploys the resources that best enable the organization to do their work today and to prepare for tomorrow.

Monitoring and Appraising Results: Monitors and measures progress against plan; provides real time supportive and corrective feedback and assistance.

Representing and Responding to Stakeholders: Prepares and delivers presentations to and managers productive relationships with critical stakeholders; recognizes and responds to the diverse needs of key inside and outside stakeholders.

Intervening In and Managing Conflict: Monitors and referees the normal and inevitable individual, team, and business unit conflicts; offers assistance and direction that moves to productive resolution. Utilizes productive conflict as a source of creativity, enhanced trust, and effective interpersonal problem solving.

Investing In and Assuring Future Leadership: Actively supports a vigorous talent management and succession process that provides a continuous flow of senior talent well into the future.

Senior-Level Clinical Leadership in Related Industry Experience: Experience in financial roles of increasing scope and responsibility; credibility earned from having served at least 20 years in executive finance positions in publicly traded or not-for-profit health organizations. Significant experience interacting with the board of directors and its audit committee and managing the organization’s relationship with banks and outside auditors.

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.

Salary Range

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Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. 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

We welcome all
All applicants are welcome and 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.

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[email protected]