Point32Health
Healthcare
Director,MedicalPolicy
Neural analysis suggests this role is
optimal for Director candidates.
“Director, Medical Policy at Point32Health. Skills: Medical Policy, Regulatory compliance, Staff management. Lead enterprise Medical Policy department activities. Lead, direct, and modify business processes”
What You'll Achieve.
Improve administrative efficiencies; Optimize results; Optimize value; Achieve objectives; Mitigate risks; Mitigate gaps; Ensure compliance; Support organizational effectiveness; Support organizational priorities; Reach corporate goals; Reach corporate objectives; Meet audit requirements; Achieve business goals; Achieve professional goals; Realize budget targets; Maintain cost effective staffing
Industry & Context.
Complex tasks; Analysis; Assessment; Evaluation; Risk mitigation; Gap identification
Work outside offices, Work to weekends, Work to holidays, Travel to meetings, Travel to events, Simultaneous use of telephone and PC, Sitting for extended durations, Additional hours beyond standard schedule
What They're Looking For.
Must Have
5+ years experience, Subject matter expertise in medical technology assessment, Subject matter expertise in medical policy development, Subject matter expertise in medical policy implementation
Nice to Have
Advanced analytic skills, Advanced assessment skills, Advanced evaluation skills, Inter-personal skills, Leadership skills
What You'll Do.
Lead enterprise Medical Policy department activities
and modify business processes
Ensure compliance with business rules
Ensure compliance with regulatory requirements
Ensure compliance with accrediting requirements
Identify and oversee analysis of process changes
Improve administrative efficiencies
Optimize results and value
Direct teams to achieve objectives
Lead cross departmental initiatives
Lead cross company initiatives
Represent Point32Health to outside organizations
Represent Point32Health to vendors
Represent Point32Health to agencies
Oversee clinical teams
Oversee non-clinical teams
Represent Vice President Medical Affairs
Balance personal workload
Balance supervisory responsibilities
Make strategic recommendations
Make complex recommendations
Take on complicated tasks
Support Enterprise-Wide Medical Technology team
Support Enterprise-Wide Medical Policy team
Support Enterprise-Wide Medical Technology processes
Support Enterprise-Wide Medical Policy processes
Ensure key performance measures are in place
Ensure outcomes measures are in place
Utilize performance measures for assessment
Utilize outcomes measures for management
Monitor quality standards
Manage quality standards
Lead inter-departmental projects
Maximize efficiency of resources
Ensure application of regulatory requirements
Ensure consistency of medical policy implementation
Provide support to organizational project teams
Direct existing requirements impacting medical policy
Manage evaluation of new requirements impacting medical policy
Develop strategies to mitigate risks
Develop processes to mitigate risks
Develop strategies to mitigate gaps
Develop processes to mitigate gaps
Ensure compliance with requirements
Promote consistency of application of regulatory requirements
Ensure appropriate department documentation
Ensure appropriate department structure
Support reliable departmental performance
Support interdepartmental performance
Evaluate opportunities to support organizational effectiveness
Evaluate opportunities to support organizational priorities
Marshal dedicated work efforts
Reach corporate goals
Reach corporate objectives
Manage implementation of changes
Evaluate impact of new regulations
Evaluate impact of new legislation
Ensure department readiness for audits
Foster cross training
Support adequate depth of skill mastery
Lead employee engagement activities
Lead employee engagement initiatives
Manage team budget process
Realize department administrative budget targets
Maintain cost effective staffing levels
How You'll Work.
Team & Collaboration
Cross departmental initiatives; Cross company initiatives; Organizational project teams
Communication Scope
Represent Point32Health; Evaluate impact; Make recommendations
Process & Methodology
Project teams, Committees
Full Job Description
**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](https://www.point32health.org/). **Job Summary** The Director, Medical Policy has responsibility for leading the organization’s enterprise Medical Policy department activities. The Director leads, directs and modifies business processes and operations ensuring compliance with Point32Health business rules and develops, implements, and refines systems and processes to ensure compliance with all relevant regulatory and accrediting requirements for these functional areas. The Director will demonstrate subject matter expertise in the areas of medical technology assessment and medical policy development and implementation for the organization. She/he ensures that initiatives are on schedule and within budget, and guides strategy, policies, and protocols in accordance with organizational goals. He/she is responsible to identify and oversee the analysis and implementation of process changes to improve administrative efficiencies and optimize results and value for his/her teams’ work. The Dire
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