Job Summary
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.

Job Description

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/