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Job Summary
The Quality Improvement Manager is responsible and accountable for leading key components of the WellSense Quality Performance Improvement Program, including consultation regarding clinical and operational quality improvement initiatives. The manager is assigned to the New Hampshire and/or Massachusetts contracts and oversees clinical quality improvement initiatives that comply with contractual obligations, regulatory requirements, and accreditation standards. The role supports process and operational improvements related to clinical initiatives within the Quality Department, evaluates projects and programs, and ensures compliance with business objectives and contractual obligations.
Our Investment In You
Full-time remote work
Competitive salaries
Excellent benefits
Key Functions/Responsibilities
Serves as Quality Management subject matter expert to medical and/or behavioral health programs and executes new strategic quality initiatives to support corporate goals including NCQA accreditation.
Provides day-to-day oversight of quality improvement needs in all products and quality requirements.
Chairs workgroups and committees overseeing progress of corporate, regulatory, and contractual quality improvement initiatives.
Ensures the Plan meets contractual requirements for medical and/or behavioral health quality improvement projects.
Develops detailed project plans and timelines for performance improvement implementations and reviews.
Facilitates multidisciplinary project teams and sub‑teams, establishing metrics, outcome measures, and interventions tailored to expectations.
Generates supporting documentation for new project proposals, including internal and external reports.
Works with clinical/quality, data analytics, and other teams to identify data needs and incorporate data analysis into the process.
Acts as liaison with vendors to incorporate vendor data into regulatory and internal reports.
Prepares timely submissions, responds to regulatory inquiries, and represents the Plan at state Quality Management meetings.
Coordinates submission of all regulatory and quality related projects to ensure on‑time, complete delivery.
Develops and implements processes to utilize internal and external data sources for identifying performance improvement interventions.
Manages day‑to‑day quality processes including document preparation, literature reviews, and web searches requiring independent decision‑making.
Maintains regular and reliable attendance.
Performs other duties as assigned.
Qualifications
Education Required:
Bachelor’s Degree in nursing, health administration or related field, or equivalent combination of training and experience.
Master’s Degree in Social Work, Behavioral Health, Public Health, or related field preferred.
Experience Required:
5+ years progressive experience in health care / managed care.
In‑depth knowledge of clinical quality management and related business goals, with preferred experience in Medicaid/Medicare recipients and community services.
Prior experience with NCQA preferred.
Experience in project development and/or health policy preferred.
Lean Six Sigma or CPHQ training preferred.
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.
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.