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

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

Under the direction of the Vice President of the Senior Vice President of Behavioral Health, the Senior Director of BH Clinical Programs oversees the BH Care Management, BH Utilization Management and Clinical Programming teams. The Senior Director develops and integrates the strategies to enhancing the quality of care for patients, satisfaction, healthcare outcomes in a c

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

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

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

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

The Manager Clinical Audit provides oversight and leadership of the Clinical Audit Team within the Payment Integrity Department. The Clinical Audit team performs detailed medical record and chart audit review of the health plan's claims to ensure that all reimbursement to the provider is paid accurately. The Clinical Auditors are a liaison and resource between the health

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

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

Uses SAS and/or SQL coding to pull claims and membership data to support involved healthcare analytics Supports the development of effective medical management programs/initiatives through analyzing, monitoring, and reporting the effectiveness of these programs Develops and implements plans to measure and report on corporate wide health care delivery cost and utilization

Responsible for accurate and timely implementations of pharmacy benefits and operations configurations Provides project management support for all pharmacy services initiatives across all lines of business Responsible for initiation, planning, tracking, documenting, execution, and monitoring and controlling of program implementations Proactively works with the project tea

Responsible for the daily supervision and operations of the Prior Authorization Specialists. Develops training, trains staff, assigns work, implements policies and procedures, and resolves complex issues to ensure accurate and timely management of prior authorization requests. Maintains compliance with state and federal requirements. Performs quality assurance audits. Imp

Reporting to the Director of BH and LTSS Network Strategy, in this highly visible role, the Manager of Behavioral Health Network is responsible for contracting the entire BH Network for the Medicare, Medicaid and Commercial suite of products across multiple states. The Manager of BH Network will be a central point of contact for the BH Network. Will enable a high performi

The Staff Accountant is a key member of the Accounting team and works closely with all members of the team in meeting close deadlines, working with various general ledger modules, preparing account reconciliations, and supporting internal and external audits. Positive and team oriented work ethic is critical to this role. Our Investment in You Full time remote work Compet