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.

The Risk Adjustment Performance/Program Manager will manage and monitor day to day operational activities and various programs within risk adjustment department. Establish and track project KPIs, coordinate and support vendors in project execution, and work with both internal & external stakeholders to foster successful outcomes. Success will require a high degree of Risk Adjustment exposure, the ability to translate data into action, & a collaborative approach to solve complex situations with internal & external (providers) stakeholders.

Our Investment in You:

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

Key Functions/Responsibilities:

• Coordinate risk adjustment program projects including developing project plans, workflows and timelines
• Track and communicate project status, timeframes, deliverables, and KPIs to multiple stakeholders and department leadership
• Manage day to day operations of vendors associated with risk adjustment department projects
• Partner with Risk Adjustment Leadership, Clinical, and Financial Analytics teams to define opportunities and areas of focus to optimize risk adjustment performance across all products and drive solutions.
• Assist with development, revision, and execution of Standard Operational Procedures, workflows, and process documentation policies for risk adjustment programs
• Partner with risk adjustment provider education staff to collaborate on prospective provider engagement strategy
• Assist with development and execution of Standard Operational Procedures, workflows, and process documentation policies for risk adjustment programs
• Partner with analytics staff to identify reporting opportunities that will assist in KPI tracking and streamlined workflows
• Other duties as assigned

Supervision Exercised:

• Program & Results

Supervision Received:

• General supervision is received

Qualifications:

Education:

• Bachelor’s Degree

Education Preferred:

• MBA in Business or HealthCare Administration

Experience Required:

• Minimum of 3-5 years’ experience with risk adjustment models
• Maintains current view of risk adjustment regulatory changes and product-specific risk model changes; ensures appropriate operational responses to regulatory and risk adjustment program
• Government Health Plan experience or managing experience with value based programs within a providers office
• Experience in a highly regulated setting with a focus on compliance & quality of outcomes
• Excel, PowerPoint Experience
• Experience having deadline driven work & meeting those deadlines

Experience Preferred/Desirable:

• Familiarity with risk adjustment or related healthcare payer programs preferred

• Understanding of value-based payment structures across various products (Medicare, Medicaid, Commercial)

• Health Plan experience or experience managing programs within a providers office

• Experience implementing and operationalizing new programs

Competencies, Skills, and Attributes:

• Ability to think strategically and understand how program decisions impact overall business goals
• Ability to coordinate cross functional teams to execute complicated workflows and tasks
• Effective collaborative and proven process improvement skills
• Strong oral and written communication skills; ability to interact within all levels of the organization
• Demonstrated ability to successfully plan, organize and manage projects
• Act like an owner, be self-driven and own the results
• Ability to run meetings independently as needed and create agendas that tie back to results
• Strong analytical and problem solving skills
• Ability to work independently in a remote home based environment
• A strong working knowledge of Microsoft Office products (Excel, PPT, Office, Outlook)

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.

• WellSense will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.