WellSense Health Plan · 3 hours ago
Quality Improvement Manager
United States
Full-time
Remote
Mid, Senior Level
$77K/yr - $112K/yr
5+ 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 Improvement Manager is responsible for leading quality improvement initiatives, ensuring compliance with regulatory standards, and promoting a culture of continuous improvement across the health plan.
Hospital & Health Care
No H1B
Responsibilities
Develop and implement quality improvement strategies aligned with organizational goals and regulatory requirements (e.g., NCQA, CMS, state regulators)
Analyze clinical and operational data to identify trends, gaps, and opportunities for improvement
Lead root cause analyses and corrective action planning for identified issues
Monitor and report on key performance indicators (KPIs), including state specific quality measures, HEDIS and CAHPS
Keep current with industry trends, regulatory changes, and best practices in healthcare quality
Build strong relationships and collaborate with provider groups to review performance data, identify barriers, and implement targeted interventions to improve quality performance
Supports accreditation and compliance activities, coordinating submission requirements and ensuring timely and accurate submission of required reports to regulatory and accrediting bodies
Ensure compliance with all contractual and regulatory requirements for medical and/or BH related quality improvement projects:
Create detailed project plans and timelines for implementing and reviewing performance improvement project
Lead workgroups, facilitate large multidisciplinary project teams and collaborate with key stakeholders to develop targeted interventions and drive quality improvement initiatives
Collaborates with external vendors on quality improvement projects, monitoring vendor performance
Actively participates in state Quality meetings, collaborating with state leaders and other health plan associates on quality improvement initiatives
Performs literature reviews to support quality improvement initiatives
Perform other duties as assigned
Qualification
Required
Bachelor's Degree in nursing, health administration, behavioral health, public health or related field
Minimum 5 years of experience in healthcare quality improvement, preferably within a health plan
Strong knowledge of managed care regulations, NCQA accreditation standards, HEDIS measures, and CMS Stars
Proficiency in data analysis and insights
In-depth knowledge of quality improvement methodologies and performance measurement tools
Excellent communication, leadership, and project management skills
5+ years progressive experience in health care or managed care
Demonstrated ability to lead cross-functional teams and large-scale projects
Preferred
Master's degree
CPHQ, Lean Six Sigma or Project Management certification
Experience working with providers
Benefits
Excellent 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
Funding
Current Stage
Late StageLeadership Team
Heather Thiltgen
President & CEO
Diana Cruz
Chief Operating Officer
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