WellSense Health Plan · 3 days ago
Quality Performance Strategist
United States
Contract
Remote
Mid, Senior Level
$77K/yr - $112K/yr
4+ years expWellSense Health Plan is a growing regional health insurance company with a 25-year history of providing health insurance that works for their members. The Quality Performance Strategist is responsible for leading quality performance activities that meet regulatory and accreditation requirements, ensuring successful project delivery and alignment with organizational goals.
Hospital & Health Care
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
Qualification
Required
Bachelor's degree in healthcare, public health, health administration, or a related field, or equivalent combination of education and relevant experience
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
Successful completion of pre-employment background check
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
Regular and reliable attendance is an essential function of the position
Preferred
Master's degree in public health, healthcare administration, or related field
PMP, Lean Six Sigma, or CPHQ certification
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
Benefits
Medical
Dental
Vision
Pharmacy
Merit increases
Flexible Spending Accounts
403(b) savings matches
Paid time off
Career advancement opportunities
Resources to support employee and family wellbeing
Company
WellSense Health Plan
A nonprofit health plan serving Medicare, Individual & Family, and Medicaid plan members in Massachusetts & New Hampshire.
1001-5000 employees
H1B Sponsorship
WellSense Health Plan has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (1)
2024 (8)
2023 (2)
2021 (2)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Heather Thiltgen
President & CEO
Diana Cruz
Chief Operating Officer
Company data provided by crunchbase