Vice President of Care Management

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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 Vice President of Care Management is a senior leadership role, responsible for designing, implementing, and optimizing care management strategies and innovative clinical programs. This position ensures high-quality, cost-effective care delivery, drives member engagement, and supports organizational goals for improved health outcomes and operational efficiency.

Our Investment in You:

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

Key Functions/Responsibilities:

• Strategic Planning and Clinical Leadership:
• Develop and execute the vision and strategy for care management delivery and innovative program development aligned with organizational objectives.
• Identify emerging trends and integrate best practices into care management models in alignment with product lines with the objective of improving health outcomes and meeting all contractual and regulatory requirements.

• Program Development & Innovation:
• Design and implement new models of care, including population health initiatives, chronic disease management, and social determinants of health programs.
• Champion digital health solutions and technology-enabled care coordination.
• Identify and execute on care management performance improvement opportunities.

• Operational Oversight:
• Lead care management teams to ensure effective utilization management, case management, and quality improvement initiatives.
• Monitor performance metrics, utilization patterns, and outcomes to drive continuous improvement.
• Engage and partner with BMC clinical leadership in support of all ACO care management needs.
• Ensure that each staff member receives the appropriate supervision and professional development. Leads, mentors and coaches direct reports to implement and carry out their essential duties.

• Collaboration & Stakeholder Engagement:
• Partner with internal departments at Plan and System levels and external stakeholders to ensure seamless program execution driving Quality Program and Population Health excellence.
• Build strong relationships with providers, health systems, community organizations, and regulators in support of organizational mission and goals.

• Compliance & Risk Management:
• Ensure adherence to regulatory requirements, accreditation standards, and all care management contractual obligations.
• Mitigate operational and clinical risks through proactive strategies.

• Budget Management:
• Develop and manage the budget for Care Management required by the Plan to efficiently meet clinical operation needs.
• Provide leadership and direction to ensure the most appropriate utilization of company resources in executing organizational and departmental goals and objectives, including evaluation with business owners of appropriate resource allocation, priority, and timeline.
• Identify opportunities for cost savings without compromising quality or operational efficiency

Supervision Exercised:

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

Supervision Received:

• General supervision is received weekly.

Qualifications:

Education Required:

• Registered nurse, with current active license
• Bachelor of Science in Nursing (BSN) required

Education Preferred:

• Master of Science in Nursing (MSN) or Master’s degree in a health related/public health field preferred
• Certification in case management (CCM) strongly preferred.

Experience Required:

• 10+ years of progressive leadership experience in managed care, care management, or health plan operations.

Required Licensure, Certification or Conditions of Employment:

• Active RN license in MA and NH or Compact license arrangement
• Successful completion of pre-employment background check

Competencies, Skills, and Attributes:

• Excellent communication, interpersonal, and leadership skills.
• Excellent relationship and consensus-building skills.
• Ability to multi-task, prioritize, and deliver in a demanding and constantly changing environment.
• Knowledge of healthcare regulations, quality improvement methodologies, and population health management.
• Strong independent judgment, critical and analytical thinking, and decision-making skills required.
• Experience with Medicaid and Medicare population strongly preferred.
• Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts.
• Knowledge of analytics, metrics, and an ability to interpret data.
• Demonstrated ability to successfully plan, organize and manage programs and projects.

Working Conditions and Physical Effort:

• Regular and reliable attendance is an essential function of the position.
• Fast paced office environment.
• Required to travel to regional offices and meetings in the regions.
• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.

 Compensation Range 

$188,000 - $272,500

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

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