Program Manager, Clinical Insights

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Program Manager, Clinical Insights is responsible for implementing and managing programs designed to improve health outcomes and strengthen financial performance overall and at the product level. Program coordination will take place across multiple clinical stakeholder groups such as care management, utilization management, and quality teams.

The Program Manager, Clinical Insights supports programs and clinical best practices with the objective of improving health outcomes, preventing hospital readmissions, improving member safety and reducing medical errors, and promoting health and wellness activities, where appropriate. The position may engage in functions of health information technology development that enhances or maintains activities associated with QI initiatives, accreditation, and monitoring, measuring or reporting clinical effectiveness and outcomes.

Our Investment in You:

* Full-time remote work

* Competitive salaries

* Excellent benefits

Key Functions/Responsibilities:

* Implement and manage member health promotion programs associated with NCQA Population Health Management standards, and general member health and wellness programs designed to improve health outcomes and reduce inappropriate utilization, including pilots and new program design interventions

* Lead performance improvement projects associated with annual Performance Improvement budget and corporate goals, assembling stakeholders to design, execute, and monitor projects

* Manage and drive execution on outbound campaigns and selective member outreach, partnering with Care Management teams and Quality

* Key point of contact to engage with marketing on overall clinical, member facing information

* Support centralization of active member outreach by various teams

* Support program monitoring through the use of analytic dashboards and KPIs

Supervision Exercised:

* None

Supervision Received:

* General supervision is received weekly.

Qualifications:

Education:

* Bachelor's degree or equivalent combination of education and relevant experience in a health plan setting required

Education Preferred/Desirable:

* Master's degree in business or health related/public health field preferred

Experience:

* 3+ years of healthcare/managed care experience

* 3+ years in program management, healthcare operations, or other applicable work experience

* Managed care experience in NCQA accreditation, care management, population health, or quality programs

Certification or Conditions of Employment:

* Successful completion of pre-employment background check

Competencies, Skills, and Attributes:

* Exceptional written and oral communication skills.

* Excellent organizational skills and attention to detail

* Demonstrated ability to work independently and manage multiple complex projects simultaneously

* Proactive, motivated, and a collaborative team player

* Demonstrated ability to adapt quickly to changing priorities

* Strong critical thinking, analytical, and problem-solving skills

* Proficiency with MS tools including Word, Excel, PowerPoint, Visio and MS Project

* Demonstrated ability of managing competing priorities as well as stakeholders with differing objectives/perspectives.

Working Conditions and Physical Effort:

* Able to perform all work from a remote environment

* Occasional travel may be required

* Regular and reliable attendance is an essential function of the position

Compensation Range

$69,500 - $100,500

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note: This range is based on Boston-area data, and is subject to modification based on geographic location.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees