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Nurse Care Manager SCO
WellSense Health Plan
-
Boston, MA
Manages a panel of high risk, medically complex members Completes timely initial and on going face to face comprehensive assessments with Member to evaluate Member's medical, behavioral health, functional status, and socioeconomic needs Administers MDS HC assessments and other required assessment tools Facilitates meetings of the PCT and serves as clinical subject matter
Email Job
Posted Today
Care Management Coordinator, SCO
WellSense Health Plan
-
Boston, MA
Generates and/or distributes member documents and files Data entry of confidential member information into multiple databases Generates simple reports for care management team Initiates and follows up on requests for provider information Assists in scheduling Primary Care Team meetings and exchanging information, facilitating communication among team members as needed Ass
Email Job
Posted Today
Pharmacy Operations Specialist
WellSense Health Plan
-
Boston, MA
Receive, process, and review all prior authorization requests received through fax, phone, or electronic prior authorization systems in accordance with all regulatory and accreditation requirements Properly apply clinical policy criteria to the review of prior authorization requests Review and interpret member's eligibility, claim history, and Pharmacy Program information
Email Job
Posted 1 day ago
Manager of Risk Adjustment and Trend Analytics
WellSense Health Plan
-
Boston, MA
The Manager of Risk Adjustment and Trend Analytics is a key member of the Finance management team. Under supervision of the V.P of Financial Planning and Performance Analysis, the Manager oversees risk adjustment analysis primarily related to the MassHealth Medicaid and New Hampshire Medicaid lines of business, directly impacting and improving the revenue for these produc
Email Job
Posted 1 day ago
Customer Service Trainer
WellSense Health Plan
-
Boston, MA
The Operations Trainer develops a wide variety of training programs and materials to support the Claims, Call Center, and Enrollment teams. The trainer researches, develops, and facilitates in house training courses for new and existing employees. Develops training competency tools that will ensure the quality, consistency and timeliness of department activities. Maintain
Email Job
Posted 1 day ago
Broker Account Executive
WellSense Health Plan
-
Boston, MA
Reporting to the Manager of Consumer Sales and Performance, the Broker Account Executive is a licensed sales professional with experience in Medicare/Medicare Advantage and individual ACA markets and is responsible for building and managing relationships with WellSense's contracted brokers. The Broker Account Executive provides strategy support and product training broker
Email Job
Posted 1 day ago
Senior Health Data Analyst
WellSense Health Plan
-
Boston, MA
WellSense Health Plan is seeking a dedicated and experienced Senior Health Data Analyst to join our team on a full time, regular basis. The Senior Health Data Analyst is a key member of the team and serves as a strategic partner to various functional areas throughout the organization to meet corporate objectives. Under the leadership and guidance of Senior Director of Cli
Email Job
Posted 2 days ago
Business Data Analyst - Customer Experience Specialist
WellSense Health Plan
-
Boston, MA
Monitors actual FCR and NPS performance against corporate targets; presents findings; proactively investigates and communicates explanations for variation and conducts root cause analysis. Provides critical data analysis and recommendations to establish corporate goals related to FCR and NPS. Conducts deep analysis on data related to FCR and NPS, reviews member surveys, l
Email Job
Posted Today
Transition of Care Clinical Care Manager
WellSense Health Plan
-
Boston, MA
The Clinical Care Manager provides holistic medical care management services for members throughout the continuum of care by assessing the member clinically as well as member's readiness to make behavioral changes and actively participate in a care plan, establish goals and meet those goals. Well Sense Health Plan members may include those who have chronic conditions and
Email Job
Posted 2 days ago
Operations Reporting and Performance Analyst (Learning and Development)
WellSense Health Plan
-
Boston, MA
The Operations Reporting and Performance Analyst (ORPA) plays an essential role in improving organizational effectiveness by analyzing operational data and identifying opportunities for learning and development. The OPRA collects and analyzes data to assess performance metrics, identifies training needs, and implements strategies to improve employee performance and skill
Email Job
Posted 2 days ago
Executive Assistant to the President
WellSense Health Plan
-
Boston, MA
The Executive Assistant role provides comprehensive administrative support to the WellSense President and executive team in managing daily business operations, communications and coordination both internally and externally. We seek a collaborative team player who is proactive, detail oriented, and highly accountable. A high degree of professionalism is essential, as this
Email Job
Posted 2 days ago
Behavioral Health Program Manager
WellSense Health Plan
-
Boston, MA
At the direction of the Manager of Behavioral Health Operations, the Behavioral Health (BH) Program Manager, New Hampshire (NH) is responsible for leading and resolving high visibility behavioral health (BH) initiatives, issues and priorities through significant interface with the health plan's material subcontractor. Key deliverables include the oversight of New Hampshir
Email Job
Posted 2 days ago
Senior IT Project Manager
WellSense Health Plan
-
Boston, MA
Responsible for the coordinated management of multiple large scale, critical or complex projects. The Senior IT Project Manager (PM) is responsible for overseeing all aspects of project work to ensure that goals and objectives are accomplished within the constraints of the budget, schedule, and stakeholder expectations. Monitors progress according to plan, identifying and
Email Job
Posted 2 days ago
Provider Relations Consultant (Boston/Northeast MA) - $5,000 sign on bonus!
WellSense Health Plan
-
Boston, MA
Investigate, document, track and assist with claims resolution Interact with various operational departments to assure accurate and timely payment of claims in accordance with WellSense policies and procedures Identify system changes impacting claims processing and work internally on resolution Identify systematic issues and trends and research for potential configuration
Email Job
Posted 3 days ago
Nurse Care Manager (Senior Care Product) - Field Based
WellSense Health Plan
-
Boston, MA
Manages a panel of high risk, medically complex members Completes timely initial and on going face to face comprehensive assessments with Member to evaluate Member's medical, behavioral health, functional status, and socioeconomic needs Administers MDS HC assessments and other required assessment tools Facilitates meetings of the PCT and serves as clinical subject matter
Email Job
Posted 3 days ago
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