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Culture and Engagement Program Manager
WellSense Health Plan
-
Boston, MA
The Culture and Engagement Program Manager is responsible for developing strategies to improve engagement, and manage programs and processes designed to foster it, such as the employee engagement survey, employee recognition, training and development, wellness and other activities aimed at creating a positive workplace environment. Implement and drive an integrated cultur
Email Job
Posted 3 days ago
Licensed Behavioral Health Clinician
WellSense Health Plan
-
Manchester, NH
The Licensed Behavioral Health Clinician provides care management services at facilities, in the community and telephonically for WellSense members receiving behavioral health (BH) and substance use services. The Licensed Behavioral Health Clinician works alongside medical Utilization Management and medical Care Management staff, pharmacists, and medical directors as part
Email Job
Posted 6 days ago
Manager of Behavioral Health Payment Strategy
WellSense Health Plan
-
Boston, MA
The Manager of Behavioral Health Payment Strategy will lead policy development and performance initiatives to align with the organization's corporate strategy and contractual/compliance requirements posed by regulatory oversight agencies, including CMS, MassHealth, NH Medicaid, and the DOI. This individual will ensure payment policy and payment system compliance and accur
Email Job
Posted 5 days ago
Payment Policy Manager
WellSense Health Plan
-
Boston, MA
Develops and maintains corporate payment policies, and works collaboratively with the Clinical Editing Manager to ensure consistency with the Plan's adjudication system(s) Monitors DHHS, EOHHS, and CMS websites, listservs and other sources to identify existing payment practice and upcoming changes Determine the scope and impact of the change on Plan operations and seek to
Email Job
Posted 6 days ago
Fee and Reimbursement Regulatory Manager
WellSense Health Plan
-
Boston, MA
Develops, maintains and manages all plan fee schedules and code pricing. Monitors multi state regulations including DHHS, EOHHS, and CMS websites, listservs and other sources to identify existing payment practice and proposed changes. Determine the scope and impact of the change on Plan operations and seek to implement changes as necessary. Business owner in managing soft
Email Job
Posted 6 days ago
Business Encounter Data Analyst
WellSense Health Plan
-
Boston, MA
The Business Encounter Data Analyst is responsible for compiling and analyzing encounter data and understanding the claim impact of changes and decision to the business process to ensure that CMS and State Service Level Agreements (SLAs) are achieved. This individual will support the encounter data lifecycle process working closely with business and technical resources as
Email Job
Posted 6 days ago
Broker Account Executive - Healthcare
WellSense Health Plan
-
Boston, MA
Reporting to the Manager of Consumer Sales and Performance, the Broker Account Executive is a licensed sales professional with experience in Medicare/Medicare Advantage and individual ACA markets and is responsible for building and managing relationships with WellSense's contracted brokers. The Broker Account Executive provides strategy support and product training broker
Email Job
Posted 7 days ago
Nurse Care Manager SCO
WellSense Health Plan
-
Boston, MA
Manages a panel of high risk, medically complex members Completes timely initial and on going face to face comprehensive assessments with Member to evaluate Member's medical, behavioral health, functional status, and socioeconomic needs Administers MDS HC assessments and other required assessment tools Facilitates meetings of the PCT and serves as clinical subject matter
Email Job
Posted 10 days ago
Care Management Coordinator, SCO
WellSense Health Plan
-
Boston, MA
Generates and/or distributes member documents and files Data entry of confidential member information into multiple databases Generates simple reports for care management team Initiates and follows up on requests for provider information Assists in scheduling Primary Care Team meetings and exchanging information, facilitating communication among team members as needed Ass
Email Job
Posted 10 days ago
Business Data Analyst - Customer Experience Specialist
WellSense Health Plan
-
Boston, MA
Monitors actual FCR and NPS performance against corporate targets; presents findings; proactively investigates and communicates explanations for variation and conducts root cause analysis. Provides critical data analysis and recommendations to establish corporate goals related to FCR and NPS. Conducts deep analysis on data related to FCR and NPS, reviews member surveys, l
Email Job
Posted 10 days ago
Manager of Risk Adjustment and Trend Analytics
WellSense Health Plan
-
Boston, MA
The Manager of Risk Adjustment and Trend Analytics is a key member of the Finance management team. Under supervision of the V.P of Financial Planning and Performance Analysis, the Manager oversees risk adjustment analysis primarily related to the MassHealth Medicaid and New Hampshire Medicaid lines of business, directly impacting and improving the revenue for these produc
Email Job
Posted 11 days ago
Customer Service Trainer
WellSense Health Plan
-
Boston, MA
The Operations Trainer develops a wide variety of training programs and materials to support the Claims, Call Center, and Enrollment teams. The trainer researches, develops, and facilitates in house training courses for new and existing employees. Develops training competency tools that will ensure the quality, consistency and timeliness of department activities. Maintain
Email Job
Posted 11 days ago
Transition of Care Clinical Care Manager
WellSense Health Plan
-
Boston, MA
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
Email Job
Posted 12 days ago
Senior Health Data Analyst
WellSense Health Plan
-
Boston, MA
WellSense Health Plan is seeking a dedicated and experienced Senior Health Data Analyst to join our team on a full time, regular basis. The Senior Health Data Analyst is a key member of the team and serves as a strategic partner to various functional areas throughout the organization to meet corporate objectives. Under the leadership and guidance of Senior Director of Cli
Email Job
Posted 12 days ago
Operations Reporting and Performance Analyst (Learning and Development)
WellSense Health Plan
-
Boston, MA
The Operations Reporting and Performance Analyst (ORPA) plays an essential role in improving organizational effectiveness by analyzing operational data and identifying opportunities for learning and development. The OPRA collects and analyzes data to assess performance metrics, identifies training needs, and implements strategies to improve employee performance and skill
Email Job
Posted 12 days ago
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