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, Inpatient manages Utilization Management (UM) Clinicians in day to day operations of the UM Process and is responsible for medical management activities related to utilization and discharge planning for acute inpatient, LTAC, rehabilitation and skilled nursing as well as Out of Network Management. S/he is accountable for implementation, monitoring and oversight of department functions and programs and the delivery of defined metrics to validate business unit/program effectiveness. The Manager, Inpatient works collaboratively with appropriate Point32Health departments and staff to identify and address opportunities to improve service, reduce administrative cost and demonstrate outcomes for functions and programs within jurisdiction. The Manager must have working knowledge of all Point32Health product lines to provide cross coverage for other Clinical Services Inpatient Managers. The Manager works collaboratively with the divisional case management departments, contracted provider and employers to address opportunities to improve service to and optimize the business relationships, while meeting the Point32Health business and quality goals. The Manager, Inpatient partners to support the delivery of services through integrated care teams to support an optimal wellness and care experience for the individual member. The Manager is accountable for recruitment, evaluation, management and development of Team Managers within jurisdiction. This position reports to the Senior Manager, Inpatient UM.

Job Description

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

• Business Process Implementation and Oversight
• Staff Development
• Resource Management
• Corporate Participation
• Other projects and duties as assigned.

Qualifications – what you need to perform the job

Certification and Licensure

Registered Nurse with current Massachusetts license preferred.

Education

Required (minimum): BS degree in nursing

Preferred: Master’s degree (nursing, business, healthcare administration), or equivalent experience.

Experience

Required (minimum): 5 years’ Registered Nurse, Leadership experience in managed care systems and operations. Demonstrate sound knowledge of utilization management and case management principles. Experience will demonstrate a functional knowledge of utilization management within a variety of payment models. Expertise in business process changes and leading people.

Preferred:

Skill Requirements

Ability to work cooperatively as a team member across multiple levels within the organization. Results orientation to meet business goals. Critical and Analytic thinking – must understand cause and effect, internal and external impact of business changes and Point32Health information systems. Influencing others – particularly those outside of direct reporting relationships. Strong communications skills (formal and informal, written and verbal). Coaching and Mentoring - primarily of reports, but also of others. Must have commitment to excellence in customer service. Considers creative alternatives to traditional/conventional practices and takes risk when appropriate to the situation. Regard for confidential data and adherence to corporate compliance policy. Ability to handle multiple demands--must be able to balance multiple priorities. Initiative, sound judgment, and the ability to work under pressure in a constantly changing environment balancing multiple priorities and utilizing resources aggressively.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

Must be able to work under normal office conditions and work from home as required. Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations. May be required to work additional hours beyond standard work schedule. Travel required as needed. Occasional evening, weekend, early morning, or extended day work may be required.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Salary Range

$101,216.82 -$151,825.24

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 https://www.point32health.org/careers/benefits/

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.

Scam Alert

Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org.