Reporting to the Director of Contracting, the Operations Manager leads and oversees the reports, audits and other issues concerning all provider contracts, including any pertinent changes and modifications applicable to these contracts. Establishes and monitors Key Performance Indicators. Accountable for quarterly provider directory management, online provider directory i

The WellSense Health Plan Manager of Hospital and Physician Contracts is responsible for the development, implementation and management of a cost effective provider network, maintaining complex and geographically diverse contracts. The Manager leads a team of Hospital and Physician Contract Managers and is responsible for the development of network wide ancillary strategi

The Manager of Healthcare Analytics is responsible for financial analysis, measurement, and contract compliance as it relates to WellSense's Clinical Vendors. Working closely with Finance leadership, clinical leadership, and leaders from WellSense's Clinical Vendors, the Manager will ensure the financial integrity of these partnerships by leading the development and commu

The Manager of Contracting oversees all activities of the Contracting team in WellSense Health Plan's New Hampshire market. Spearheads the development, implementation and management of cost effective, accessibly adequate, culturally diverse provider networks and assists with regulatory adequacy submissions of the same. Under the direction of the Director of Contracting an

The WellSense Plan Manager of Ancillary Contracts is responsible for the development, implementation and management of a cost effective provider network, maintaining complex and geographically diverse contracts. Serves as mentor and manage o Ancillary Contract Managers, leading in the development of network wide ancillary strategies to improve efficiencies and access. Und

The Clinical Care Manager provides holistic medical care management services for members throughout the continuum of care by assessing the member clinically as well as member's readiness to make behavioral changes and actively participate in a care plan, establish goals and meet those goals. Well Sense Health Plan members may include those who have chronic conditions and

Provide Real Time (RTA) support which includes taking calls from Workforce Planning Helpdesk, WFP emails and other ad hoc tasks Maintenance of workforce management tool which includes staff and forecasting alignment, vacancy management, and interactions between IEX and service center representatives Provide reporting to management team that helps drive optimum resource ut

Provide short and long term forecasts for various contact centers and departments Including inbound and outbound calls, emails, faxes, chats, written correspondence, claims, enrollment files, caseloads, and other volume based measures Maintenance of current and long term staffing requirements needed to meet service level objectives and other key performance indicators Sup

Position Health Data Analyst III (2 positions available) Location Charlestown (Boston), MA. Report to main office in Charlestown, MA. Eligible to work remotely from anywhere in the U.S. but must work from a state the employer is legally eligible to employ Alabama, Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland

Under the direction of the Vice President of the Senior Vice President of Behavioral Health, the Senior Director of BH Clinical Programs oversees the BH Care Management, BH Utilization Management and Clinical Programming teams. The Senior Director develops and integrates the strategies to enhancing the quality of care for patients, satisfaction, healthcare outcomes in a c

Reporting to the Vice President of Network Strategy, the Director of Behavioral Health Network Strategy is responsible for contract strategy and execution for WellSense Health Plan's behavioral health (BH) network for Medicare, Medicaid and Commercial products across multiple states. The Director of BH Network Strategy will be a thought leader and central point of contact

The Operations Trainer role is pivotal in elevating new and existing employee's performance and capabilities through classroom and virtual training sessions. The role primarily supports Health Plan Operations departments such as Member and Provider Service, Claims, Member Enrollment, and Provider Appeals. The Operations Trainer will also conduct job specific training, inc

Leads the rate development process by providing analyses and recommendations on benefit design, rating factors, trend picks, and projection of future claim cost. Oversees regulatory rate filings and prepares data or response for additional inquiries. Leads the development of monthly IBNR reserve estimates for different line of business. Oversees monthly accruals and contr

Strategy and Vision Contribute to the development and articulation of a comprehensive AI/ML and automation strategy aligned with the overall business objectives, with a particular focus on end to end data quality, specifically in the areas of health equity and encounters. Execute the vision for AI/ML and automation technologies, ensuring alignment with industry trends and

Responsible for organizational readiness for specific NCQA standard areas Provides consultation to organizational areas about NCQA standard compliance, reporting and report writing. Assists with management of the Quality Improvement Committee. Creates documentation related to NCQA evidence. Implements quality improvement projects and processes related to NCQA requirements