Vice President, Affordability (Canton)

Who We ArePoint32Health 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 SummaryPoint32Health 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 Total Cost of Care Team 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 NeedWe are seeking an executive who can:Translate complex affordability and utilization trends into actionable enterprise strategies and operational decisionsInfluence senior leaders and drive alignment across highly matrixed environmentsBalance financial, operational, clinical, regulatory, and member experience considerations simultaneouslyLead through ambiguity, complexity, and organizational transformationCommunicate difficult tradeoffs and recommendations with clarity, credibility, and executive presenceBuild strong partnerships while holding teams accountable for measurable affordability outcomesOperate as an enterprise strategist — not simply a functional affordability expertUnderstand the interconnected impacts across utilization management, pharmacy, provider economics, care management, network strategy, and Total Cost of Care performanceKey ResponsibilitiesEnterprise Affordability StrategyLead the development, refinement, and execution of a comprehensive enterprise affordability strategy focused on reducing Total Cost of Care across all lines of businessEstablish enterprise affordability priorities aligned to financial targets, regulatory expectations, competitive positioning, and member outcomesPartner with executive leadership to integrate affordability goals into operational planning, enterprise governance, and performance management processesIdentify and prioritize the highest-impact affordability opportunities across clinical, operational, network, and product domainsEnterprise Influence & Executive PartnershipServe as a trusted advisor to executive leadership on affordability trends, medical cost pressures, utilization patterns, and market dynamicsTranslate complex analytics and operational insights into clear executive recommendations and actionable next stepsLead enterprise-level discussions involving tradeoffs, prioritization, investment decisions, and affordability strategy executionPresent affordability performance, emerging risks, and strategic recommendations to executive leadership and Board committeesCost Analytics, Total Cost of Care Team & Performance ManagementOversee and partner closely with the Total Cost of Care Team and related analytical functions to ensure affordability strategies are informed by robust data, actionable insights, and measurable outcomesPartner closely with Actuary, Finance, and analytics teams to assess medical cost performance, utilization trends, and affordability opportunitiesEstablish transparent and consistent affordability reporting, measurement frameworks, and performance indicators across business linesEvaluate leading and lagging indicators to proactively identify affordability risks and intervention opportunitiesClinical & Operational IntegrationPartner with Clinical Operations, Care Management, Population Health, Pharmacy, and Government Programs leadership to optimize care models and improve affordability performanceIdentify opportunities to reduce avoidable utilization, improve care coordination, and strengthen outcomes for high-cost populationsEnsure affordability initiatives support both business performance and high-quality, member-centered care deliveryIntegrate health equity considerations into affordability and care model strategies where appropriateProvider Strategy & Value-Based CareCollaborate with Provider Partnerships, Finance, and Actuarial teams to strengthen value-based payment strategies and provider performance modelsSupport provider incentive structures, risk-sharing arrangements, and network affordability initiatives aligned to enterprise TCOC goalsDrive transparency, accountability, and partnership with providers around affordability outcomes and performance expectationsLeadership & Organizational EffectivenessLead and influence teams across a highly matrixed enterprise environmentBuild strong cross-functional relationships and foster shared accountability for affordability outcomesOperate effectively in fast-paced, evolving, and complex environments requiring agility, sound judgment, and executive maturityContribute to broader enterprise transformation and performance improvement efforts as a strategic leaderQualifications10+ years of progressive executive leadership experience in healthcare affordability, medical economics, health plan finance, provider economics, or related areasSignificant 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 performanceDemonstrated success driving measurable Total Cost of Care reduction initiatives in complex healthcare organizationsDeep understanding of healthcare economics, utilization management, value-based care, provider reimbursement, and regulatory dynamicsStrong executive communication and influence skills, with the ability to engage effectively across clinical, operational, financial, and executive audiencesProven ability to lead in highly matrixed, complex, and evolving organizationsStrong strategic thinking, problem-solving, and organizational leadership capabilitiesExperience operating in Medicare Advantage, Medicaid, risk-based commercial, or value-based care environments strongly preferredExperience in turnaround, transformation, or cost-constrained environments preferredMaster’s degree in Healthcare Administration, Business, Public Health, Economics, Data Science, or related field preferredClinical background (MD, RN, PharmD) or actuarial credentials are valued but not requiredLeadership ExpectationsAligned with Point32Health leadership expectations, this executive will:Demonstrate enterprise-first leadership and strategic decision-makingLead with clarity, accountability, and operational disciplineInfluence across functions and levels with credibility and partnershipNavigate ambiguity and complexity with confidence and sound judgmentBuild alignment and momentum in highly matrixed environmentsDrive measurable business outcomes while maintaining a member-centered perspectiveSalary Range$285,000.00 -$350,000.00Compensation & Total Rewards OverviewThe 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 coverageRetirement plansPaid time offEmployer-paid life and disability insurance with additional buy-up coverage optionsTuition programWell-being benefitsFull suite of benefits to support career development, individual & family he