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Job · Canton, MA · Full time

Vice President, Network Strategy & Operations

Tufts Associated Health Maintenance Organization · $2.56B budget · 582 staff · Since 1979

This job has closed.

Why Tufts Associated Health Maintenance Organization

FY2024 · Form 990Its mission and biggest programs, as filed

Provides affordable, coordinated health care coverage for low-income seniors eligible for both Medicare and Medicaid.

  • Program service accomplishments - massachusetts medicare product tahmo also offers products to medicare eligible enrollees. Tufts Health plan medicare preferred (Tufts medicare preferred) provides affordable Health coverage to its members in massachusetts. Tufts medicare preferred strives to provide coverage options…$1.84B spent in FY2024
  • Program service accomplishments - dual-eligible program the Organization also provides access to affordable care through a dual-eligible program. Tahmo provides coverage for people age 65 or older who are eligible for masshealth standard, have both medicare part a and b…$405.7M spent in FY2024
  • PROGRAM SERVICE ACCOMPLISHMENTS - COMMERCIAL HMO PRODUCT ONE OF TAHMO'S LARGEST PRODUCTS IS ITS COMMERCIAL HMO WHICH PROVIDES AFFORDABLE HEALTH COVERAGE TO ITS MEMBERS. TAHMO STRIVES TO PROVIDE HMO COVERAGE THAT IS AFFORDABLE, AND PROVIDES ACCESS TO TOP QUALITY HEALTH…$305.5M spent in FY2024

Before you apply

FY2024 · Form 990Independent: from IRS data, not the org
Peers pay
$146K–$266K
$10M+ orgs, Massachusetts
Fine: from the org's Form 990.
Pt VII · Sec A
Pays its leaders
$5K
1 officer reported
Fine: from the org's Form 990.
Pt VII · Sec A
Budget
$2.76B
spent in FY2024
Fine: from the org's Form 990.
Pt I · Ln 18
Staff
582
employees
Fine: from the org's Form 990.
Pt I · Ln 5–6
Spent on programs
93%
of spending
Looks good: 93% of spending went to programs; 75% or more.
Pt IX · Ln 25 · col B
Surplus or deficit
−8%
of revenue, FY2024
Concern: revenue was below expenses in the latest filing.
Pt I · Ln 19
Cash reserves
2 mo
of spending, in cash and securities
Fine: 1.7 months of spending in cash; 1 to 3.
Pt X · Ln 1–2 · Pt I · Ln 18
Latest return
FY2024
latest Form 990
Looks good: the latest return is for FY2024, 2 tax years back; within 2 tax years.
IRS e-file
IRS status
501(c)(4)
tax-exempt since 1979
Looks good: listed by the IRS.
IRS BMF
Looks goodFineWorth a lookConcernTap a box for the reason.

About the role

The org's own posting, as written

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 Vice President, Network Strategy & Operations is responsible for leading the execution of network-related functions underpinning the enablement of contracts supporting all lines of business. This leader will devise strategy for standardizing, streamlining, digitizing, and optimizing enabling functions that comprise the end-to-end provider experience. The scope of responsibilities include provider contracting operations/updates, and provider enrollment and credentialing. To be successful, the VP, Network Strategy & Operations will have awareness of cross enterprise dependencies and will collaborate cross functionally with various functions within each Point32Health line of business.

This role requires innovative thought leadership and will be key to modernizing Point32Health’s interface with its provider network(s) with both local and national partners. This modernization includes process scrutiny, optimization and transparency, and digitization of rote processes. The role also requires innovation related to the operating model for engaging providers broadly, and specifically in getting provider partners to collaborate with the plan in pursuit of modernization of co-dependent processes (e.g. enrollment, credentialing, roster integrity, provider data integrity).

Job Description

DUTIES/RESPONSIBILITIES – what you will be doing: Lead the Network Operations Function. In collaboration with LOB and SLT leadership, overlay an operating model that reflects the integrated entities’ strategic targets Oversee contract implementation, ensuring all key terms are correctly configured in claims administrative platforms Ensure continual innovation and improvement on implementation processes: seize opportunities to reduce steps, redundancy, and to produce ‘single process” across LOBs Ensure excellence within the Provider Operations (provider enrollment & credentialing) In collaboration with lines of business (LOB), oversee the strategic development and implementation of…

Read the full posting

About Tufts Associated Health Maintenance Organization

From its Form 990

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