WellSense Health Plan ยท 2 weeks ago
Vice President of Care Management
United States
Full-time
Remote
Director/Executive
$188K/yr - $272K/yr
10+ years expWellSense Health Plan is a growing regional health insurance company dedicated to providing health insurance that works for its members. The Vice President of Care Management is responsible for designing and optimizing care management strategies, ensuring high-quality care delivery, and driving member engagement to improve health outcomes and operational efficiency.
Hospital & Health Care
Responsibilities
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
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
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
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
Ensure adherence to regulatory requirements, accreditation standards, and all care management contractual obligations
Mitigate operational and clinical risks through proactive strategies
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
Qualification
Required
Registered nurse, with current active license
Bachelor of Science in Nursing (BSN) required
10+ years of progressive leadership experience in managed care, care management, or health plan operations
Active RN license in MA and NH or Compact license arrangement
Successful completion of pre-employment background check
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
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
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 with Medicaid and Medicare population strongly preferred
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