Manager of Care Management Operations

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:

Under the direction of the Sr. Director of OCA Operations and Performance, the Manager of Care Management Operations is responsible for operational oversight of care management programs including but not limited to performance dashboards and reporting, relationship management with care management stakeholders and collaborators, strategic engagement and oversight with IT partners and program leads surrounding care management system and technology solutions, and accountability of projects and initiatives requiring engagement across care management teams.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Identifies as a key point of contact within the organization for developing care management operational accountability on projects or work streams while partnering with Care Management leadership to provide appropriate oversight and relationship management with key collaborators across the enterprise
• Assesses and develops programming to support operational and management activities within care management aligned to strategic priorities and objectives
• Engages stakeholders across Care Management to develop and maintain effective metrics to monitor productivity and compliance. Accountable for timely notification to leadership if performance falls below expectations. Collaborates with CM leadership to identify opportunities for improvement and implementation of interventions to address opportunities.
• Identifies, communicates, and escalates issues on a timely basis. Independently problem solves programmatic issues and implements appropriate solutions.
• Serves as SME for, workflows/processes and initiatives related to Care Management Programs, and works with other business areas including IT and Clinical Informatics on business requirement development to support program sustainability and product expansion
• Supports annual review and updates of departmental policies, job aids and workflows for revision to meet model of care changes, and to ensure continued regulatory and contractual compliance. Promotes standardization of workflows, policies and documentation to ensure that there is a solid database from which to report and evaluate programs and build out economies of scale.
• Supports efforts to ensure compliance with NCQA standards and new contractual obligations, ensuring opportunities for improvement are identified and corrective action initiated within established timelines as required by the Accreditation Manager and Public Partnerships. Works with Clinical Trainers to incorporate regulatory requirement changes into ongoing training.
• Serves as a lead to care management teams and strategic partner/accountable party with IT as it relates to strategy, oversight, and operational improvements for the care management documentation system, including but not limited to leading new initiatives, evaluating modules, ongoing system enhancements, inclusive of care management business lead on pre-production and regression testing.
• Demonstrates a passion for leading positive change by continuously improving and defining innovative operations

Supervision Exercised:

• Directly or indirectly oversees management of 5-15 non-clinical staff

Supervision Received:

• General supervision is received weekly.

Qualifications:

Education Required:

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

Education Preferred:

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

Experience Required:

• 5 years of healthcare/managed care experience
• 5 years project/ program management experience or other applicable work experience

Experience Preferred:

• Experience supervising staff

Required Licensure, 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
• Ability to interact with all levels of the organization, as well as external stakeholders.
• Superior meeting facilitation skills and experience in leading cross-functional teams
• 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.
• Ability to analyze, compile, format, and present data to a variety of stakeholders.
• 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.
• Effective at forming alliances with other departments to develop partnerships and commitment toward completing the project.
• Able to negotiate enterprise solutions with other departments that work interdepartmentally.

Working Conditions and Physical Effort:

• Able to perform some work from a remote environment.
• Fast-paced environment.
• No or very limited physical effort is required. No or very limited exposure to physical risk

Regular and reliable attendance is an essential function of the position

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.