Lead high impact quality initiatives that directly shape care for Medicaid and Medicare members across Massachusetts and New Hampshire. This full time, work from home role is made for someone who can think strategically, manage complex projects, and still sweat the details on compliance and performance.
About WellSense Health Plan
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual & Family, and Medicaid plans. Founded as Boston Medical Center HealthNet Plan, WellSense is built around one goal: providing health coverage that works for people, no matter their circumstances. The organization is committed to diversity, inclusion, and improving health equity in the communities it serves.
Schedule
- Position type: Full time, remote
- Location: Work from home within the United States
- General hours: Standard weekday business hours, with flexibility based on project and meeting needs
- Collaboration: Regular cross functional work with clinical, analytics, operations, and regulatory teams
What You’ll Do
- Serve as a subject matter expert for Quality Management across medical and/or behavioral health programs.
- Lead key components of the Quality Performance Improvement Program for NH and/or MA contracts.
- Oversee day to day quality improvement needs across products and quality requirements.
- Chair workgroups and committees responsible for driving progress on corporate, contractual, and regulatory quality initiatives.
- Ensure compliance with contractual and regulatory requirements (EOHHS, DHHS, EQRO, NCQA, and other accreditation bodies).
- Develop detailed project plans and timelines for performance improvement projects and track progress to completion.
- Facilitate multidisciplinary project teams to define outcome metrics, measures of success, and targeted interventions.
- Generate and maintain supporting documentation and reports for internal leadership and external regulators.
- Partner with clinical/quality and data analytics teams to define data needs, perform analyses, and incorporate findings into quality initiatives.
- Serve as liaison with vendors and incorporate vendor data into quality and regulatory reporting.
- Prepare and submit required quality and regulatory reports on time and in full.
- Represent the plan at state Quality Management meetings and coordinate internal input for external discussions.
- Use internal and external data sources to identify trends, interventions, and new performance improvement topics.
- Manage day to day quality processes including document preparation, literature review, web based research, and related tasks requiring independent decision making.
What You Need
- Bachelor’s degree in nursing, health administration, or a related field; or an equivalent combination of training and experience.
- Master’s degree in Social Work, Behavioral Health, Public Health, or a related field preferred.
- At least 5 years of progressive experience in healthcare or managed care.
- Strong knowledge of clinical quality management and business practices in managed care.
- Experience working with Medicaid/Medicare populations and community services preferred.
- Prior experience with NCQA and performance improvement projects strongly preferred.
- Background in project development and/or health policy is a plus.
- Lean Six Sigma, CPHQ, or similar quality training preferred.
- Proven ability to lead complex, cross functional initiatives and communicate with stakeholders at all levels.
- Excellent written and verbal communication, organization, and problem solving skills.
Benefits
- Salary range of approximately 77,000 to 111,500 dollars annually, based on experience, education, and location.
- Comprehensive benefits package including medical, dental, vision, and pharmacy coverage.
- Paid time off, paid holidays, and merit increase opportunities.
- Flexible Spending Accounts and 403(b) savings matches.
- Full time remote work with a stable, mission driven health plan.
- Career growth opportunities and resources to support employee and family wellbeing.
If you’re ready to own meaningful quality work instead of just “supporting” it, this is a strong move—especially if you want remote stability with room to grow.
Happy Hunting,
~Two Chicks…