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
Point32Health is seeking a seasoned enterprise affordability leader to drive and accelerate our organization-wide affordability strategy across Commercial, Individual & Small Group, Medicare, Duals, and Medicaid lines of business throughout New England.
This executive will lead enterprise efforts to reduce Total Cost of Care (TCOC), improve medical cost performance, and strengthen long-term affordability for members, employer groups, and the broader healthcare ecosystem. The role requires a highly strategic and influential leader who can translate complex financial, clinical, operational, and market dynamics into clear enterprise action and measurable results.
This is not solely an analytics or reporting role. Success requires the ability to influence senior executives, align highly matrixed teams, challenge conventional thinking, and drive enterprise execution across clinical, operational, financial, and provider-facing functions.
The ideal candidate brings deep expertise in healthcare affordability, medical economics, provider economics, value-based care, utilization management, and payer operations, along with the executive presence and communication skills necessary to operate effectively with the CEO, ELT, Board committees, regulators, and external partners.
This leader will oversee and partner closely with the Medical Economics function and collaborate across Clinical Operations, Finance, Actuary, Product, Provider Partnerships, Government Programs, Population Health, Care Management, Pharmacy, and line-of-business leadership to identify affordability opportunities, drive accountability, and improve enterprise performance in a highly dynamic and evolving healthcare environment.
What We Need
We are seeking an executive who can:
Translate complex affordability and utilization trends into actionable enterprise strategies and operational decisions
Influence senior leaders and drive alignment across highly matrixed environments
Balance financial, operational, clinical, regulatory, and member experience considerations simultaneously
Lead through ambiguity, complexity, and organizational transformation
Communicate difficult tradeoffs and recommendations with clarity, credibility, and executive presence
Build strong partnerships while holding teams accountable for measurable affordability outcomes
Operate as an enterprise strategist — not simply a functional affordability expert
Understand the interconnected impacts across utilization management, pharmacy, provider economics, care management, network strategy, and Total Cost of Care performance
Key Responsibilities
Enterprise Affordability Strategy
Lead the development, refinement, and execution of a comprehensive enterprise affordability strategy focused on reducing Total Cost of Care across all lines of business
Establish enterprise affordability priorities aligned to financial targets, regulatory expectations, competitive positioning, and member outcomes
Partner with executive leadership to integrate affordability goals into operational planning, enterprise governance, and performance management processes
Identify and prioritize the highest-impact affordability opportunities across clinical, operational, network, and product domains
Enterprise Influence & Executive Partnership
Serve as a trusted advisor to executive leadership on affordability trends, medical cost pressures, utilization patterns, and market dynamics
Translate complex analytics and operational insights into clear executive recommendations and actionable next steps
Lead enterprise-level discussions involving tradeoffs, prioritization, investment decisions, and affordability strategy execution
Present affordability performance, emerging risks, and strategic recommendations to executive leadership and Board committees
Cost Analytics, Medical Economics & Performance Management
Oversee and partner closely with the Medical Economics team and related analytical functions to ensure affordability strategies are informed by robust data, actionable insights, and measurable outcomes
Partner closely with Actuary, Finance, and analytics teams to assess medical cost performance, utilization trends, and affordability opportunities
Establish transparent and consistent affordability reporting, measurement frameworks, and performance indicators across business lines
Evaluate leading and lagging indicators to proactively identify affordability risks and intervention opportunities
Clinical & Operational Integration
Partner with Clinical Operations, Care Management, Population Health, Pharmacy, and Government Programs leadership to optimize care models and improve affordability performance
Identify opportunities to reduce avoidable utilization, improve care coordination, and strengthen outcomes for high-cost populations
Ensure affordability initiatives support both business performance and high-quality, member-centered care delivery
Integrate health equity considerations into affordability and care model strategies where appropriate
Provider Strategy & Value-Based Care
Collaborate with Provider Partnerships, Finance, and Actuarial teams to strengthen value-based payment strategies and provider performance models
Support provider incentive structures, risk-sharing arrangements, and network affordability initiatives aligned to enterprise TCOC goals
Drive transparency, accountability, and partnership with providers around affordability outcomes and performance expectations
Leadership & Organizational Effectiveness
Lead and influence teams across a highly matrixed enterprise environment
Build strong cross-functional relationships and foster shared accountability for affordability outcomes
Operate effectively in fast-paced, evolving, and complex environments requiring agility, sound judgment, and executive maturity
Contribute to broader enterprise transformation and performance improvement efforts as a strategic leader
Qualifications
10+ years of progressive executive leadership experience in healthcare affordability, medical economics, health plan finance, provider economics, or related areas
Significant payer-side experience required, including demonstrated understanding of the interconnected impacts across utilization management, pharmacy, care management, provider economics, network strategy, and Total Cost of Care performance
Demonstrated success driving measurable Total Cost of Care reduction initiatives in complex healthcare organizations
Deep understanding of healthcare economics, utilization management, value-based care, provider reimbursement, and regulatory dynamics
Strong executive communication and influence skills, with the ability to engage effectively across clinical, operational, financial, and executive audiences
Proven ability to lead in highly matrixed, complex, and evolving organizations
Strong strategic thinking, problem-solving, and organizational leadership capabilities
Experience operating in Medicare Advantage, Medicaid, risk-based commercial, or value-based care environments strongly preferred
Experience in turnaround, transformation, or cost-constrained environments preferred
Master’s degree in Healthcare Administration, Business, Public Health, Economics, Data Science, or related field preferred
Clinical background (MD, RN, PharmD) or actuarial credentials are valued but not required
Leadership Expectations
Aligned with Point32Health leadership expectations, this executive will:
Demonstrate enterprise-first leadership and strategic decision-making
Lead with clarity, accountability, and operational discipline
Influence across functions and levels with credibility and partnership
Navigate ambiguity and complexity with confidence and sound judgment
Build alignment and momentum in highly matrixed environments
Drive measurable business outcomes while maintaining a member-centered perspective
Salary Range
$285,000.00 -$350,000.00
Compensation & Total Rewards Overview
The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. 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 Company’s 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 buy-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, visit https://www.point32health.org/careers/benefits/
We welcome all
All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Scam Alert Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org
Guiding and empowering healthier lives for everyone.
