Point32Health Jobs in United States

The Director of Configuration and Operations of the claim adjudication systems drives configuration strategy and execution ensuring accurate setup of claims adjudication products benefits payment processes and automation of business processes. · Hires manages trains both direct n ...

We are a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. · ...

The Director of Contracting is responsible for contract strategy, · development, · negotiation, · and implementation for hospitals, · physician groups,and integrated delivery systems across multiple markets and products. · ...

The Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute is currently seeking a Postdoctoral Fellow to help implement and lead health policy research. · Contribute to the creation of analytic data sets using large, complex data fro ...

The Member Appeals and Grievance Analyst is responsible for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. · This individual works collaboratively with the member and/or the member's auth ...

We are seeking a highly motivated Project Manager to join the Division of Health Policy and Insurance Research (HPI). The team studies effects of high-cost medical care and health insurance innovations to improve health outcomes. · Manage large research projects with multiple sit ...

The Supervisor of member Services is responsible for maintaining up-to-date knowledge of Point32Health products and communicating changes to staff; providing accurate and thorough interpretation of Point32Health benefits, claims processes, eligibility and enrollment policies to m ...

Job Summary · Harvard Pilgrim Health Care Institute (HPHCI) is currently seeking a highly motivated, action-oriented, and resourceful Project Manager to join the Division of Health Policy and Insurance Research (HPI). · The Project Manager will provide overall management of resea ...

Under the direction of the Pharmacy Utilization Management (UM) Supervisor, the Clinical Pharmacist is responsible for reviewing, processing and managing the daily caseload of pharmacy prior authorization (PA) requests for coverage determinations (CD), and exceptions. · ...

Job Description · The Director of Contracting is responsible for contract strategy, development, negotiation, and implementation for hospitals, physician groups, and integrated delivery systems across multiple markets and products. · Develop provider networks to meet goals for ac ...

The Performance Manager (Product Strategy) is responsible for supporting product strategy design, planning, and end-to-end performance management for Point32Health's dual eligible products., inclusive of products serving under and over 65 members in Massachusetts ("One Care", and ...

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 prov ...

Protecting Point32Health's legal interests while maintaining its operations within established boundaries. · ...

The Manager Security Operations will lead team responsible for identity access management security event monitoring and operational support across enterprise systems cloud environments. This role focuses on achieving operational excellence improving efficiency ensuring compliance ...

The Department of Population Medicine (DPM) at Harvard Medical School and Harvard Pilgrim Health Care Institute (HPHCI) is a research and teaching collaboration between Harvard Pilgrim Health Care and Harvard Medical School, · The Research Assistant will work in the Division of H ...

We're seeking highly motivated individuals to join our organization as an Analytics & Triage Fraud Analyst within our Special Investigations Unit (SIU). · The SIU is responsible for analyzing claim trends, patterns and outliers, · developing and refining queries to detect potenti ...

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 ...

+Participate in studies evaluating the effects of recent policies on mental and substance use disorders treatment.+Analyze large data from multiple sources.+Make presentations to technical and non-technical audiences+Perform out-of-the-box thinking,+collaborate with others, and m ...

The Care Manager – Nursing Field (RN CM) will ensure that all members receive timely care management across the continuum, · Perform telephonic member outreach and/or face-to-face encounter utilizing key motivational interviewing skills to facilitate program enrollment. · Provide ...

This position will lead the Risk Adjustment Operations & Provider Consulting team responsible for the department's program management, provider engagement and consultation activities supporting the complete and accurate capture of risk adjustment data.This individual will develop ...