Job Information
WellSense Quality Improvement Manager in United States
Quality Improvement Manager
WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, no matter their circumstances.
Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294438)
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 Quality Improvement Manager is responsible and accountable for leading key components of the WellSense Quality Performance Improvement Program including consultation regarding clinical and operational quality improvement initiatives. The Quality Improvement Manager is assigned to the New Hampshire and/or Massachusetts contracts. The Quality Improvement Manager is responsible and accountable for clinical quality improvement initiatives which comply with contractual obligations, regulatory requirements and accreditation standards. As applicable, this individual will provide support for process and operational improvements related to clinical initiatives within the Quality Department. They also oversee quality improvement initiatives by program management involving significant cross-functional interface complexity, risk and cost. Additionally, they have the ability to evaluate project/program options and to make recommendations that meet overall business objectives, as well as work with leaders at all levels throughout the company to ensure the success of the program and compliance with all contractual obligations.
Our Investment in You:
· Full-time remote work
· Competitive salaries
· Excellent benefits
Key Functions/Responsibilities:
Serves as Quality Management subject matter expert to the medical and/or behavioral health (BH) programs and executes new strategic quality initiatives designed to support corporate goals including NCQA accreditation
Provides day-to-day oversight of quality improvement needs in all products and quality requirements
Chairs the workgroups and committees which oversee progress with all corporate, regulatory, and contractual quality improvement initiatives
Ensures the Plan meets contractual (e.g. EOHHS, DHHS, EQRO, NCQA and other regulatory/ accreditation bodies) requirements for medical and/or BH related quality improvement projects:
Develops detailed project plans and timelines for performance improvement project implementations and reviews
Facilitates large multidisciplinary project teams and smaller sub-teams so that each performance improvement project has appropriate outcome metrics, measures of success, and interventions that are specific to meet expectations
Generate supporting documentation for new project proposals, including internal and external reports
Works with clinical/quality, data analytics team and others as needed, to ensure that data needs are identified and incorporated into the process including performing data analysis as needed
Serves as the liaison with vendors, as appropriate; to incorporate vendor data into assigned regulatory and/or internal reports
Prepares timely submissions for assigned projects, and responds to regulatory inquiries regarding submissions
Represents the Plan at state Quality Management meetings as needed
Solicits internal input in preparation for external meetings
Coordinates the submission of all regulatory and quality related projects so that they are submitted on time and complete
Develops and implements a process to utilize internal and external data sources, including quarterly reports, monthly management reports and population studies to identify interventions and potential topics for performance improvement projects initiatives
Manages day-to-day quality processes including document preparation, literature reviews, and web–search requiring a high degree of independent decision-making
Regular and reliable attendance is an essential function of the position
Other duties as assigned
Qualifications:
Education Required:
Bachelor’s Degree in nursing, health administration or related field or the equivalent combination of training and experience
Master’s Degree in Social Work, Behavioral Health, Public Health, or related field preferred
Experience Required:
5+ years progressive experience in health care / managed care
In depth knowledge of and experience with clinical quality management and related business goals and practices within related areas preferred
Experience with Medicaid/Medicare recipients and community services preferred
Prior experience with NCQA preferred
Experience in project development and / or health policy preferred
Lean Six Sigma or CPHQ training preferred
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
Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294438)
Important info on employment offer scams:
According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not reach out to individuals via text, we do not ask or require downloads of any applications, or “apps”, and applicant screenings, interviews and job offers are not conducted over text messages or social media platforms. We do not ask individuals to purchase equipment for, or prior to employment. To avoid becoming a victim of an employment offer scam, please followthese tips from the FTC (https://consumer.ftc.gov/consumer-alerts/2023/01/looking-job-scammers-might-be-looking-you?utm_source=govdelivery) .