Point32Health

Manager

• Manages Utilization Management (UM) Clinicians in day to day operations of the UM Process
• 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
• Accountable for implementation, monitoring and oversight of department functions and programs
• Works collaboratively with Point32Health departments and staff to improve service and demonstrate outcomes
• Partners to support the delivery of services through integrated care teams

Inpatient Manager

Controller

• Manage the month-end and quarter-end close processes and related accounting staff for multiple health plans and insurance companies
• Work with Controller to ensure the timely publication of the monthly financial statements, including consolidated and segment results, and report on operations variances to the annual plan and reforecasts
• Work with Corporate Controller and CAO in establishing and maintaining technical accounting policies and related documentation to ensure compliance with U.S. GAAP and NAIC SSAP and reporting requirements
• Prepare special reports, as needed, by collecting, analyzing, and summarizing information and trends
• Help to facilitate internal and annual external year-end audit process with the external auditors
• Oversee the timely completion and filing of NAIC statutory statements on a quarterly and annual basis for all regulated legal entities
• Manage the timely preparation and delivery of draft audited financial statements with associated footnotes to external auditors to meet year-end reporting requirements
• Oversee the preparation of all tax filings on a monthly, quarterly, and annual basis
• Perform other duties & projects as assigned including supporting diversified business

Assistant Corporate Controller

Data Analyst

• Conduct detailed analyses of business processes and requirements.
• Translate business requirements into actionable specifications for technical teams.
• Develop and implement strategies to achieve business goals.
• Collaborate with stakeholders to understand their needs and gather requirements.
• Evaluate current business processes and systems to propose improvements.
• Perform data analysis to support decision-making processes.
• Create clear and concise documentation including business requirements, functional specifications, and test plans.
• Assist in project management activities such as planning, scheduling, and coordination.
• Conduct user acceptance testing and provide post-implementation support.
• Stay updated with industry trends and best practices in business analysis.

Business Analyst, Speech Analytics

• 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 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.

SCO RN Care Manager – North 2

• Ensure that all members receive timely care management (CM) across the continuum
• 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.
• Collaborate with member/caregiver and the facility care team to coordinate a safe transition to the next level of care
• Maintain professional growth and development through self-directed learning activities.
• 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 and liaise with the interdisciplinary care team, to improve member outcomes.

SCO RN Care Manager, Chinese Speaking Preferred

• Ensure that all members receive timely care management (CM) across the continuum
• 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 the facility care team to coordinate a safe transition to the next level of care
• Liaise with the interdisciplinary care team, to improve member outcomes
• Maintain professional growth and development through self-directed learning activities

Care Manager – Nursing

• Perform telephonic member outreach and/or face-to-face encounter utilizing key motivational interviewing skills to facilitate program enrollment.
• Perform departmental assessments and evaluate members 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, which includes but is not limited to ensure understanding post-hospital discharge instructions, facilitate needed services and follow-up, and implement strategies to prevent re-admission.
• Collaborates and liaises with the interdisciplinary care team, to improve member outcomes (i.e., Utilization Management, Medical Director, pharmacy, community health workers, dementia care specialists, wellness, and Behavioral Health CM).
• Attending and presenting (as appropriate) high risk members at interdisciplinary rounds forum.
• Maintain professional growth and development through self-directed learning activities.

Care Manager – Nursing, Field

Sales

• Provide high quality service to assist brokers with quoting on self-service tools
• Answer questions about products and plans
• Provide overall customer service related to quoting and renewals through multiple channels
• Daily monitoring of new business and renewal quotes
• Follow up with brokers and/or Account Executive
• Complete new business installs including the collection of required documentation
• Entering account information into CRM
• Completing renewal process for existing customers on annual basis
• Update systems/trackers with current account status
• Maintain current working knowledge of underwriting guidelines and multiple state regulations

Sales Installation Specialist

Project Manager

• Manage all phases of the project to ensure goals and objectives are met within the established time and budget guidelines
• Lead cross-functional team members on projects of significant complexity
• Proactively identify conflict/integration issues and lead team members to parse and synthesize issues of highest complexity
• Accurately estimate and plan resource usage
• Coach and mentor less experienced project managers
• Regularly review status of project and modify schedule as necessary
• Oversee and facilitate project team meetings and prepares status documents periodically throughout the project
• Instruct and coach team members in Project Management techniques
• Facilitate planning sessions
• Effectively resolve roadblocks to project progress
• Influence the owner, sponsor, steering committee and other appropriate senior management

Project Manager III

Supervisor

• Oversee daily operations of the service center team
• Schedule shifts and manage attendance
• Provide training and development for team members
• Track and analyze key performance indicators (KPIs)
• Conduct regular performance reviews of team members and provide feedback
• Ensure high levels of customer satisfaction
• Handle escalated customer issues and complaints
• Prepare and present reports on team performance and customer feedback
• Facilitate effective communication within the team and with other departments
• Monitor and evaluate calls for quality assurance purposes

Supervisor, Member Services

• Responsible for implementation and monitoring effectiveness of new and existing Care Management programs
• Compliance with applicable regulatory and accrediting standards
• Defining and monitoring outcomes and regular reporting for areas of accountability
• Provide direct oversight of coordinators, RN care managers and other interdisciplinary staff
• Facilitate and enhance team collaboration to optimize program and member outcomes

Clinical Manager – North Area

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 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.

Care Manager – Bilingual Preferred (Mandarin/Cantonese, Spanish a Plus)

Analyst

• Work with Federal Affairs leadership, trade associations and other stakeholders to advance organizational priorities
• Establish expertise in emerging health policy issues by attending health policy knowledge events relative to the Enterprise
• Independently track, analyze, summarize, and communicate relevant Federal legislation and regulations
• Provide technical support to departments regarding current, proposed and newly promulgated Federal guidance

Government Affairs Analyst

• Lead requirements gathering sessions with stakeholders to understand business objectives and translate them into system requirements.
• Analyze and document complex business processes and workflows, identifying areas for improvement and automation.
• Define and prioritize system enhancements and new features based on business needs and strategic goals.
• Collaborate with IT teams to design and develop solutions that meet business requirements, ensuring alignment with technical architecture and standards.
• Conduct feasibility studies, cost/benefit analyses, and risk assessments for proposed solutions.
• Manage the full lifecycle of projects from requirements gathering through to implementation and post-deployment support.
• Mentor and provide guidance to junior business systems analysts, fostering a collaborative and knowledge-sharing environment.
• Ensure compliance with regulatory requirements and best practices in systems development and implementation.
• Serve as a subject matter expert on business processes and systems, providing insights and recommendations to senior management.