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Clinical Strategy & Performance Director

5-10 years
Not Disclosed
10 Dec. 5, 2024
Job Description
Job Type: Full Time Remote Education: B.Sc./ M.Sc./ M.Pharm/ B.Pharm/ Life Sciences/ MPH/ MBA Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Clinical Strategy & Performance Director
Remote (United States)

About WellSense Health Plan:
WellSense Health Plan is a nonprofit health insurance provider serving over 740,000 members across Massachusetts and New Hampshire. For over 25 years, we've offered high-quality Medicare, Medicaid, and Individual and Family plans that prioritize accessible and equitable care.

Job Summary:
As the Clinical Strategy & Performance Director, you will lead the design, implementation, and performance oversight of clinical programs. Collaborating with clinical leadership and market leads, you will align programs with contractual, regulatory, and accreditation standards to ensure optimal outcomes. Reporting to the Senior Director of Clinical Operations and Performance, you will independently manage complex initiatives, leveraging data, KPIs, and innovation to achieve performance goals.

Key Responsibilities:

  • Clinical Program Design: Develop strategic models of care, staffing frameworks, and operational processes in collaboration with clinical leadership.
  • Performance Optimization: Use KPIs and regulatory reporting to oversee and adjust clinical programs for improved outcomes.
  • Stakeholder Engagement: Act as a primary liaison with state regulators and external partners regarding program design and performance.
  • Operational Efficiency: Identify and implement improvements to streamline workflows, reduce redundancy, and enhance member outcomes.
  • Cost Management: Develop and measure interventions to reduce medical expenses and enhance financial performance.
  • Health Equity: Lead service transformation to improve continuity of care and reduce health disparities.

Qualifications:

  • Education:
    • Bachelor’s degree in a related field required.
    • Master’s degree in business, public health, or a health-related field preferred.
    • RN or Social Work license preferred but not required.
  • Experience:
    • 5–10 years in healthcare/managed care with expertise in clinical operations, care management, and program development.
    • Experience in CMS Medicare, Medicaid, or Commercial products preferred.
  • Skills & Competencies:
    • Exceptional communication and presentation abilities.
    • Proven leadership in driving strategic initiatives and cross-functional collaboration.
    • Proficiency in Microsoft Office and strong analytical skills.
    • Effective negotiation and relationship-building expertise.

Why Join WellSense?

  • Full-Time Remote Work: Flexible, remote role with occasional travel.
  • Competitive Compensation & Benefits: Supportive work environment with excellent benefits.
  • Diversity & Inclusion: Commitment to fostering a diverse and inclusive workplace for all.

About Working at WellSense:
We offer a fast-paced, collaborative environment where your contributions directly impact member health and wellness. Join a team dedicated to innovation and improving healthcare outcomes.

To apply, visit WellSense Careers.

Equal Opportunity Employer:
WellSense values diversity and is an equal-opportunity employer. We participate in E-Verify to ensure employment eligibility.