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This job was posted by https://illinoisjoblink.illinois.gov : For more information, please see: https://illinoisjoblink.illinois.gov/jobs/11948878

Who We Are

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. To learn more about who we are at Point32Health, clickhere{target="" _blank\"\"=""}.

Job Summary

The Delegated Provider Oversight Program Manager (Program Manager) manages programs and projects with significant complexity, risk and/or cost that support assigned programs and providers delegated for Utilization Management (UM) and/or Care Management (CM) activities. Key responsibilities include medium to large scale projects and initiatives. Responsibilities include successful implementation of large cross-functional projects to support the program(s), working closely with the appropriate Point32Health staff and external stakeholders to manage programs/projects, performing thorough and detailed policy and impact analysis, leading and/or representing the program in change initiatives that affect multiple departments. The Program Manager evaluates the cost and feasibility of multiple options/alternatives to resolve program issues and to make recommendations on those issues that best meet program and corporate Point32Health, as well as objectives. Change to ongoing programs at this level will usually require facilitating cross-departmental meetings as well as negotiations with outside parties/partners and contacts to explain and justify the impact. The Program Manager will also interact directly and regularly with leadership within the department and within Point32Health and others to accomplish successful program management.

Key Responsibilities/Duties what you will be doing

Overall program management of Care Management (CM) and Utilization Management (UM) Oversight Programs, focusing on both short-term initiatives and long-term strategic direction and objectives for the programs. The Program Manager is responsible for:\ o Leading day-to-day operations relating to providers delegated for Medicare and Medicaid applicable UM and/or CM activities.\ o Collaborating with individuals and groups across the enterprise and externally on new/existing documents, processes, activities, systems, and initiatives in response to program compliance requirements. Includes data collection and analysis of documentation from various sources to meet program requirements.\ o Providing operational oversight through regular communication, education and design of programs and strategies to assist delegated providers with meeting Point32Health expectations and CMS Medicare and State Medicaid compliance requirements.

Compensation & Total Rewards Overview

As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company\'s sole discretion and may be modified at the Companys sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

• Medical, dental and vision coverage

• Retirement plans

• Paid time off

• Employer-paid life and disability insurance with additional bu -up coverage options

• Tuition program

• Well-being benefits

• Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visithttps://www.point32health.org/careers/benefits/{target="" _blank\"\"=""}

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

?Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we dofrom product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team\'s 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 re