If you’re a nurse who’s good on the phone and even better at motivating people to take care of themselves, this role is a strong match. You’ll do member outreach to close gaps in care, improve quality measures, and help people complete screenings and chronic care services that actually move outcomes.
About WellSense Health Plan
WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. They focus on delivering coverage and services that work for members in real life, with an emphasis on access, quality, and health equity.
Schedule
- Full-time
- Remote
- Compensation range: $74,000–$107,000 (may vary by geographic location)
What You’ll Do
- Make outreach calls to members with identified quality gaps in care
- Provide culturally competent education, motivational support, and scheduling assistance to help members close care gaps
- Follow up with members who need additional support to complete next steps
- Document outreach activity, track progress and results, and support reporting for quality campaigns and initiatives
- Evaluate Health Related Social Needs that may affect a member’s ability to access services
- Collaborate with internal teams to coordinate member support and resources
- Meet quality and timeliness standards tied to individual and department performance goals
- Maintain current knowledge of quality measures and best practices (HEDIS, Stars, and other measures)
- Ensure compliance with state and federal regulations for all activities performed
- Participate in quality improvement activities and cross-department meetings, supporting discussions and reporting
- Develop and maintain policies and standard operating procedures to support compliance
- Support clinical best practices focused on better outcomes, readmission prevention, and health and wellness
What You Need
- Associate degree in nursing or post high school nursing diploma (required)
- 2 years of experience as a practicing nurse in a hospital/healthcare setting or performing direct member outreach (required)
- Preferred: bachelor’s or master’s degree in healthcare or related field
- Preferred: 2+ years in health insurance and 2+ years in quality improvement
- Strong customer service mindset with excellent oral and written communication
- Strong PC skills with word processing, spreadsheets, and database tools
- Ability to maintain confidentiality and protect member privacy
- Strong process improvement skills and comfort working cross-functionally
- Knowledge of managed care, utilization management, and quality management
- Strong critical thinking, investigative, and analytical skills
- Ability to interpret policies, programs, and guidelines
- Strong organizational skills and ability to manage multiple priorities
- Successful completion of a pre-employment background check
Benefits
- Full-time remote work
- Competitive salary
- Medical, dental, vision, and pharmacy benefits
- Flexible Spending Accounts (FSA)
- 403(b) with savings match
- Paid time off
- Merit increases
- Career advancement opportunities
- Employee and family wellbeing resources
If you want a remote role where your nursing background is used to help people take action, not just read scripts, this one is worth a look.
Bring your clinical foundation, your people skills, and your follow-through, and help WellSense close care gaps that matter.
Happy Hunting,
~Two Chicks…