Point32Health

Manager

• Perform telephonic member outreach and/or face-to-face encounter utilizing key motivational interviewing skills to facilitate program enrollment.
• Perform departmental assessments and evaluate member holistically to identify needs, health goals, and barriers to wellness.
• Develop a member-specific plan of care, implement member-specific care manager interventions, and revise plan of care as needed.
• Complete documentation in applicable platform according to departmental policy and regulatory standards.
• Provide targeted health education, proactive strategies for condition management, and communication with key providers and vendors actively involved in the member’s care.
• Collaborate with member/caregiver and the facility care team to ensure a safe transition to the next level of care.
• Collaborate and liaise with the interdisciplinary care team to improve member outcomes.
• Maintain professional growth and development through self-directed learning activities.

Care Manager – Nursing

Operations

• Managing a team focused on execution of clinical pharmacy programs and strategies.
• Leading the implementation and maintenance of evidence based, cost-effective programs.
• Ensuring compliance with state and federal regulatory and accreditation requirements.
• Collaborating with PBM to optimize member experience and clinical outcomes.
• Directing support functions for the Pharmacy and Therapeutics committee.

Senior Manager, Clinical Pharmacy Operations

• Lead the delivery of a clinical and business model of the Senior Care Options Transitions/Post-Acute programs
• Oversee day-to-day operations of nurse care managers
• Manage and implement targeted interventions for cost/utilization drivers
• Collaborate with interdisciplinary team to develop geriatric-focused care management program
• Accountable for recruitment, evaluation, management, and development of clinicians overseen

Manager, Integrated Care Management – Nursing

Security Engineer

• Lead the organization's response to business operation interruptions
• Develop and implement business continuity strategies
• Educate stakeholders on their roles in crisis management
• Ensure updated disaster recovery procedures
• Manage a team of Cyber & Information Security leaders

Director, Cyber and Information Security – Operational Resiliency, Crisis Management

Analyst

• Oversee day-to-day administration of 401(k), Executive Savings Plan (ESP) and 457(b) plans, including employee enrollment, contribution processing, vesting schedules, loan and hardship withdrawal management, and distribution processing.
• Conduct regular audits and reconciliations to ensure accuracy of plan data, participant accounts, and financial reporting.
• Monitor compliance with ERISA, IRS regulations, DOL guidelines, and plan document requirements; prepare and file necessary forms (e.g., Form 5500) and respond to audits.
• Collaborate with third-party administrators, recordkeepers, and investment providers to resolve issues, implement plan changes, and optimize plan performance.
• Analyze plan utilization trends, costs, and employee feedback to recommend enhancements, such as new investment options or communication strategies.
• Administer financial programs such as tuition, HSA and banking.
• Assist in the administration of other benefits programs (e.g., health insurance, life insurance, disability, FSA/HSA) during peak periods or as business needs arise, including enrollment support, compliance/audit activities, and claims resolution.
• Develop and deliver employee education sessions, communications, and resources on benefits topics to promote awareness and utilization.
• Partner with HR partners and finance teams to forecast benefits costs, budget for plan renewals, and support open enrollment processes.
• Stay abreast of industry trends, legislative changes, and best practices in employee benefits to inform strategic recommendations.
• Maintain accurate records in HRIS systems (e.g., Workday, ADP) and generate reports for leadership on benefits metrics and KPIs.
• Serve as a subject matter expert on benefits-related inquiries from employees, managers, and vendors.
• Contribute to benefits committee meetings, vendor RFPs, and annual benefits strategy planning.
• Provide day-to-day support for retirement programs; lead annual 401(k) discrimination testing project; conduct audits to ensure integrity of the plan (i.e. ensure all eligible employees are auto-enrolled).
• Complete annual true-up process, calculate and apply annual non-elective contribution.
• Assist with ESP annual enrollment – identify participants, update communications, respond to inquiries.
• Other duties and projects as assigned.

Senior Benefits Analyst

Bilingual

• Perform telephonic member outreach and/or face-to-face encounter utilizing key motivational interviewing skills to facilitate program enrollment.
• Perform departmental assessments and evaluate member holistically to identify needs, health goals, and barriers to wellness.
• Develop a member-specific plan of care, implement member-specific care manager interventions, and revise the plan of care as needed.
• Complete documentation in applicable platform according to departmental policy and regulatory standards.
• Provide targeted health education, proactive strategies for condition management, and communication with key providers and vendors actively involved in the member’s care.
• Collaborate with member/caregiver and the facility care team to coordinate a safe transition to the next level of care.
• Collaborate with the interdisciplinary care team to improve member outcomes.
• Maintain professional growth and development through self-directed learning activities.

RN Care Manager – Senior Care Options, Bilingual Preferred (Vietnamese)

• Perform telephonic member outreach and/or face-to-face encounter utilizing key motivational interviewing skills to facilitate program enrollment.
• Perform departmental assessments and evaluate member holistically to identify needs, health goals, and barriers to wellness.
• Through assessment and collaboration with member/caregiver and providers, develop a member-specific plan of care, implement member-specific care manager interventions, and revise plan of care as needed.
• Complete documentation in applicable platform according to departmental policy and regulatory standards.
• Provide targeted health education, proactive strategies for condition management, and communication with key providers and vendors actively involved in the member’s care.
• Collaborate with member/caregiver and the facility care team to coordinate a safe transition to the next level of care.
• Collaborates and liaises with the interdisciplinary care team, to improve member outcomes.
• Maintain professional growth and development through self-directed learning activities.

RN Care Manager – Senior Care Options, Bilingual Preferred (Mandarin/Cantonese)

• Perform telephonic member outreach and/or face-to-face encounter utilizing key motivational interviewing skills to facilitate program enrollment.
• Perform departmental assessments and evaluate member holistically to identify needs, health goals, and barriers to wellness.
• Develop a member-specific plan of care, implement member-specific care manager interventions, and revise plan of care as needed.
• Provide targeted health education, proactive strategies for condition management, and communication with key providers and vendors actively involved in the member’s care.
• Collaborate with member/caregiver and facility care team to coordinate a safe transition to the next level of care.
• Maintain professional growth and development through self-directed learning activities.

RN Care Manager – Senior Care Options – Bilingual Preferred, Spanish

Implementation Specialist

• Manage the intake of Contract Implementation requests in Service Now
• Assign to relevant Associate Contract Specialist
• Monitor email boxes and track volumes where applicable.
• Store contracts and all associated documentation and information appropriately as directed by Manager
• Provide status reports on a regular basis regarding volumes and assignments.
• Prepares tracking documents and supports the Associate Contract Specialists under the guidance of the Manager
• Manages/participates in special projects.
• Other duties and projects as assigned.

Contract Implementation Specialist

Insurance

• Process complex claims: fully research and resolve complex issues and problem codes for proper adjudication
• Manually apply specific product or benefit rules to claims and manually calculate/apply pricing when necessary
• Ensure claim payment correctly reflects Point32Health’s status as primary or secondary payer through coordination of benefits
• Determine member eligibility and verify services are allowable under member benefit plan and required authorizations/referrals/pre-registrations
• Process complex claim adjustments: review requests, determine need for re-adjudication, research provider payment inquiries
• Examine and correct/update claim data; prepare and enter adjustments with appropriate back out and adjustment reason codes
• Assist partner departments and promptly research and resolve escalated issues from other departments and management
• Monitor pending claims and adjustments daily to ensure timely release for adjudication and meet quality/production standards
• Participate in identifying opportunities for process improvements and serve as SME for documentation, projects, and testing
• Act as role model and mentor to core claims processors and provide back up support to other department areas
• Responsible for timely and accurate processing of Member Reimbursements and comply with department/company guidelines and policies