Manager of Clinical Insights

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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.

Job Summary:

The Manager of Clinical Insights is responsible for leading data-informed, population based strategies across integrated clinical programs aimed to improve health outcomes and contribute to medical cost savings overall and at the product level. Working across physical and behavioral health teams, quality and pharmacy programs, the Manager will support all lines of business to establish programs that promote high performing interventions, with a critical focus on quality outcomes. The Manager will also serve as the business owner for NCQA Population Health Management standards, convening a diverse group of organizational stakeholders to assess, develop, and execute a population health program in compliance with NCQA accreditation requirements.

The Manager of Clinical Insights supports programs and clinical best practices with the objective of improving health outcomes, preventing hospital readmissions, improving member safety and reducing medical errors, and promoting health and wellness activities, where appropriate. The position may engage in functions of health information technology development that enhances or maintains activities associated with QI initiatives, accreditation, and monitoring, measuring or reporting clinical effectiveness and outcomes.

Our Investment in You:

·       Full-time remote work

·       Competitive salaries

·       Excellent benefits

Key Functions/Responsibilities:

• Organizational business owner for NCQA Population Health Management Standards, building programs that demonstrate health plan adherence to PHM accreditation standards and ongoing readiness for NCQA surveys, with targeted focus on program effectiveness
• Analyze member utilization and health data to identify trends, risks, and opportunities for improvement, and strategize across clinical stakeholders to develop and implement evidence-based programs and interventions to impact identified needs
• Active participant on the Performance Improvement Medical Cost Savings Committee, supporting intervention development for physical and behavioral health opportunities based on data analytics to product profitability and performance
• Lead and engage a team responsible for Clinical Insights analytic and program execution roles
• Act as a strategic partner with Quality and Care Management colleagues to prioritize outreach campaigns based on financial performance and/or business need
• Support technical solutions and inform design of IT platforms that meet business, accreditation and regulatory requirements
• Lead engagement with network providers on performance opportunities and programming associated with improving health outcomes and strengthening financial performance, in addition to working with external and internal stakeholders and partners on pilot opportunities
• Develop targeted health education and promotion materials and resources for member distribution

Supervision Exercised:

• Directly or indirectly oversees management of 5-15 clinical and non-clinical staff

Supervision Received:

• General supervision is received weekly.

Qualifications:

Education:

• Bachelor’s degree or equivalent combination of education and relevant experience in a health plan setting required

Education Preferred/Desirable:

• Master’s degree in business or health related/public health field preferred
• Unrestricted RN or SW

Experience:

• 5+ years of healthcare/managed care experience
• Experience managing NCQA accreditation requirements
• Experience in health data analytics, population health data, or medical economics
• Managed care experience in care management, population health, or quality programs

Certification or Conditions of Employment:

• Successful completion of pre-employment background check

Competencies, Skills, and Attributes:

• Exceptional written and oral communication skills.
• Excellent organizational skills and attention to detail
• Ability to interact with all levels of the organization, as well as external stakeholders.
• Superior meeting facilitation skills and experience in leading cross-functional teams
• Demonstrated ability to work independently and manage multiple complex projects simultaneously.
• Proactive, motivated, and a collaborative team player.
• Demonstrated ability to adapt quickly to changing priorities.
• Ability to analyze, compile, format, and present data to a variety of stakeholders.
• Strong critical thinking, analytical, and problem-solving skills.
• Proficiency with MS tools including Word, Excel, PowerPoint, Visio and MS Project
• Demonstrated ability of managing competing priorities as well as stakeholders with differing objectives/perspectives.
• Effective at forming alliances with other departments to develop partnerships and commitment toward completing the project.
• Able to negotiate enterprise solutions with other departments that work interdepartmentally.

Working Conditions and Physical Effort:

• Able to perform all work from a remote environment
• Occasional travel may be required.
•  Regular and reliable attendance is an essential function of the position.

Compensation Range: 

$88,500 - $128,000

This range offers an estimate based on the minimum job qualifications.  However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer.  This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.  

Note: This range is based on Boston-area data, and is subject to modification based on geographic location. 

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 is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

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