Director, Product Strategy Exchange - Now Hiring

The Director of Product Strategy - Exchange is responsible for the overall success of Point32Health’s Tufts Health Direct product offering. Tufts Health Direct is the #1 health plan on the Massachusetts Health Connector and serves over 150,000 individual and small group members with its Qualified Health Plans (“QHPs”) ($700M revenue). The Director is accountable for profit and loss results, enrollment growth, and achievement of the “quadruple aim” of improved member experience, higher quality care, lower costs and increased provider satisfaction. In addition to managing existing product offerings, the Director leads the evaluation of potential expansion opportunities, and if appropriate, ensures the coordination of the appliable elements of any RFP submissions and subsequent product implementations.

The Director leads a team that establishes, implements and performance manages product strategies across a highly matrixed organization, and externally, with a broad set of stakeholders (e.g., providers, regulators). Key elements of the product strategy include but are not limited to product design including detailed benefit optimization, complex commercial pricing strategies, margin targets, enrollment growth including marketing strategy and targets, population health priorities, provider network, community relations and competitive positioning. The Director is responsible for ensuring identification of the deliverables necessary to achieve the strategy and coordinating with leaders across the organization to facilitate implementation.

The Director is responsible for establishing a management structure that monitors the performance of the chosen strategies relative to established targets, including identifying key performance indicators. The Director works closely with a cross-section of functional teams (actuarial, operations, clinical services, network management, legal, compliance, finance, marketing, etc.) to establish shared accountability for the achievement of these performance objectives.

For potential expansion markets, the Director will coordinate a robust evaluation of market potential including the competitive landscape, provider environment, and policy outlook, and develop a detailed strategic recommendation for senior leadership.

Across existing and potential new markets, the Director is responsible for establishing and maintaining productive relationships with senior leaders of strategic partners, including but not limited to providers, regulators, advocates, and vendors.

The Director is expected to hire, lead, and develop a team of approximately 2 managers/analysts/coordinators.

Key Responsibilities/Duties – what you will be doing

• Develop multi-year product strategy for Tufts Health Direct
• Ensure the implementation of initiatives critical to strategic success, including the management of strategic partner relationships and/or internal performance improvement projects.
• Establish key performance objectives, monitor results, and coordinate data-driven strategic recommendations across a variety of domains including medical trend, financial and operational performance, member/provider experience, care management, network management and quality.
• Coordinate closely with enterprise leaders, including actuarial leadership, operations, network contracting, on the achievement of shared objectives.
• Develop recommendations to optimize ongoing product positioning based on market data, business, and competitive intelligence data
• Develop productive working relationships with a wide variety of external stakeholders, including providers, regulators, and advocates
• Communicate product performance to internal stakeholders, including senior leadership
• Develop evaluation framework for Point32Health’s exchange new market entry targets
• Evaluate potential near-term opportunities, including alongside potential strategic partners
• As necessary, retain and manage consulting resources to assist in market evaluation
• Present strategic recommendations to senior leadership for feedback and approval
• Develop high-functioning team of resources to support the strategy setting and execution
• Conduct regular performance reviews and provide key developmental feedback
• Effectively structure and delegate work to set-up team up for success

Qualifications – what you need to perform the job

Education, Certification and Licensure:

• Bachelor’s degree; required.
• Master’s degree: MPH, MBA, or other master’s degree with healthcare or financial focus, strongly preferred.

Experience:

• Five – Ten (5 – 10) or more years of health plan experience, preferred.
• Experience with group commercial and/or Affordable Care Act (“ACA”) health plan product management, strongly preferred.

Skill Requirements:

• Must possess maturity, and a high degree of professionalism.
• Exceptional oral and written communication skills, including for senior most audiences.
• Deep understanding of the managed care industry, health insurance product life cycle, and government healthcare.
• Expertise in commercial health plan pricing strategies, including rating development and benefit design optimization.
• Self-starter, able to think creatively, take responsibility, and be extremely resourceful.
• Enjoys, and excels, executing in complex environments with significant amounts of uncertainty and ambiguity.
• Must be able to work collaboratively across a highly matrixed organization, and drive progress through influence.
• Proven ability to build relationships with external stakeholder groups, including regulators and advocates.
• Track record of developing and advancing junior team members and building high performing teams.
• Strong analytical skills, including financial management.
• Significant experience designing quantitative and qualitative data analyses and leveraging them for data-driven decisions.
• Comfort working closely with internal and external clinicians.
• Strong project management and stakeholder management skills
• Highly organized; able to effectively delegate to team members and escalate, as appropriate.
• Experience with applicable software and database programs including Excel, Word, PowerPoint.

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.
• 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.

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Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI 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.

COVID Policy

Please note: As of January 18, 2022, all employees — including remote employees — must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

About the Company

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

This job has been posted by TalentBoost on behalf of Point32Health. TalentBoost is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of TalentBoost not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Req ID: R6037