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 Quality Performance Strategist is responsible for leading high-level quality performance activities that support regulatory, accreditation, and contractual requirements. This role provides oversight in planning, execution, and monitoring of projects that directly impact quality outcomes, including HEDIS® performance and state-specific quality initiatives. The Performance Strategist partners with internal teams, vendors, and regulatory agencies to ensure successful project delivery, timely resolution of data issues, and alignment with organizational goals. This position requires a balance of operational expertise and analytical skills, combining strong project management and cross-functional leadership with the ability to oversee data collection, analysis, and reporting. The Performance Strategist contributes to the development, implementation, and continuous improvement of quality programs by ensuring data accuracy and integrity, identifying opportunities for process enhancements, and driving results that support both compliance and organizational priorities.
Our Investment in You:
· Full-time remote work
· Competitive salaries
· Excellent benefits
Key Functions/Responsibilities:
· Lead oversight of quality performance projects from planning through execution, including monitoring deliverables, timelines, and outcomes.
· Coordinate cross-functional collaboration to ensure alignment of initiatives with regulatory and organizational goals.
· Analyze performance data including trends, issue logs, validation findings, predicted outcomes, and opportunities for improvement, to support effective decision making and project execution.
· Formulate and implement validation methods and strategies to ensure accurate and reliable data.
· Manages project timelines and deliverables by identifying key milestones, coordinating stakeholder and workgroup engagement, and overseeing timely data submission.
· Works collaboratively with key internal stakeholders to ensure accuracy of data and systems to produce unbiased HEDIS results, including researching variances among the HEDIS measures, data mapping and supplemental sources.
· Monitors updates to quality measures including Electronic Clinical Data Systems (ECDS) and provide clinical insight to their impact on data collection, reporting processes, and measure performance.
· Participates in provider engagement efforts to ensure understanding and alignment on quality metrics, documentation standards, and supplemental data capture.
· Develop recommended business solutions through research and analysis of data and business process (Population health, Health Equity accreditation and other QI data).
· Oversee vendor management activities including deliverable tracking, invoice processing, and contract negotiations for chart retrieval services, ensuring cost-effective agreements that support quality standards and compliance requirements.
· Contributes to the development of provider-facing tools and educational materials related to HEDIS® measures, and HEDIS®-relevant ICD-10/CPT coding, ensuring alignment with current NCQA requirements.
· Participates in development and implementation of systems and processes that support quality operations: supplemental data sources and year-round care gap closure.
· Performs other related duties and/or projects assigned
Supervision Exercised:
· Provides guidance and support for project-based staff, contractors, and temporary employees, no direct FTE management responsibility.
Supervision Received:
· General supervision is received weekly.
Qualifications:
Education Required:
· Bachelor’s degree in healthcare, public health, health administration, or a related field, or equivalent combination of education and relevant experience.
Education Preferred:
· Master’s degree in public health, healthcare administration, or related field.
· PMP, Lean Six Sigma, or CPHQ certification.
Experience Required:
· 4+ years of experience in healthcare quality, managed care, or project management.
· Knowledge of current and evolving NCQA HEDIS Supplemental and Administrative data processes and source requirements.
· Strong knowledge of healthcare performance measures and member-level data, including HEDIS®, Medicare Stars, Marketplace, PQA, and Medicaid-specific measures.
· Ability to translate clinical and technical information for diverse audiences and clearly communicate action plans to meet business needs.
Experience Preferred/Desirable:
· Knowledge and experience in SQL, SAS, and/or other database platforms e.g.: create and generate reports through MS-Access and SQL using direct links to core databases (Enterprise Data Warehouse).
· Experience in using Inovalon: QSI-XL certified HEDIS reporting tool, QMRM, iPORTHD, and other HEDIS software.
· Experience in internal data cleansing and data reconciliation analysis e.g.: ability to extract data – analyze and interpret results, variances, trends.
Required Licensure, Certification or Conditions of Employment:
· Successful completion of pre-employment background check
Competencies, Skills, and Attributes:
· Demonstrates exceptional troubleshooting, analytical, and problem-solving skills, coupled with the ability to formulate and communicate effective solutions.
· Ability to successfully work with minimal supervision, seeks out and seizes opportunities, finds ways to surmount barriers, and takes lead roles in working with key stakeholders and vendors.
Working Conditions and Physical Effort:
· Regular and reliable attendance is an essential function of the position.
Compensation Range
$77,000 - $111,500
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