Quality Improvement Manager
Location: 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 through Medicare, Medicaid, and Individual & Family plans. With over 25 years of experience, we are committed to delivering high-quality healthcare solutions tailored to the diverse needs of our members.
Job Summary:
The Quality Improvement Manager leads key components of the WellSense Quality Performance Improvement Program. This includes overseeing clinical and operational quality improvement initiatives and ensuring compliance with regulatory and accreditation standards. The role involves managing cross-functional projects, evaluating program options, and working with company leaders to meet business objectives and contractual obligations.
Key Responsibilities
Leadership & Strategy:
Serve as a subject matter expert on quality management for medical and/or behavioral health programs.
Develop and implement strategic quality initiatives aligned with corporate goals, including NCQA accreditation.
Project Management:
Oversee performance improvement projects, ensuring the inclusion of outcome metrics, success measures, and interventions.
Manage project timelines, facilitate project teams, and ensure successful execution of quality improvement initiatives.
Collaboration & Communication:
Coordinate with vendors, data analytics teams, and clinical/quality staff to integrate data into performance improvement projects.
Represent WellSense at state Quality Management meetings and provide input for external meetings.
Compliance & Reporting:
Ensure that quality improvement projects meet all regulatory and contractual requirements.
Prepare and submit timely regulatory and quality-related reports and respond to inquiries.
Data Utilization & Analysis:
Develop processes to analyze internal and external data to identify performance improvement opportunities.
Manage day-to-day quality processes, including document preparation and literature reviews.
Qualifications
Education:
Bachelor’s Degree in Nursing, Health Administration, or related field (required).
Master’s Degree in Social Work, Behavioral Health, Public Health, or related field (preferred).
Experience:
5+ years of progressive experience in healthcare or managed care.
In-depth knowledge of clinical quality management and related business goals.
Experience working with Medicaid/Medicare recipients and community services (preferred).
Prior experience with NCQA and health policy/project development (preferred).
Lean Six Sigma or CPHQ training (preferred).
Competencies, Skills, and Attributes
Leadership & Management:
Strong leadership and project management skills with the ability to drive cross-functional collaboration.
Quality & Compliance:
Expertise in clinical quality management and understanding of accreditation processes.
Communication & Analysis:
Excellent communication and analytical skills, with the ability to manage complex projects and collaborate with multiple stakeholders.
Problem-Solving & Adaptability:
Strong problem-solving abilities and the capacity to adapt to changing regulations and business needs.
Working Conditions
Remote Work: Full-time remote position.
Business Hours: Must be available to work East Coast business hours (9 AM – 5 PM, Monday to Friday).
Overtime: Ability to work overtime during peak periods.
Attendance: Regular and reliable attendance is essential.
Why Join WellSense?
Remote Flexibility: Enjoy the convenience of working from home.
Competitive Benefits: Comprehensive salary and benefits package.
Inclusive Culture: WellSense is committed to diversity and inclusion in staffing and member services.
Equal Opportunity Employer:
WellSense is an equal opportunity employer, committed to diversity and inclusion. Qualified applicants are considered without regard to race, gender, disability, or veteran status.
Apply Today:
Join a team dedicated to improving healthcare outcomes. Visit WellSense Careers to apply.
Important Employment Offer Scam Warning:
Beware of employment scams. WellSense only accepts applications through our website and does not conduct interviews or offer employment via text or social media.
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