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Manager of Operations for Care Management Initiatives
2 months ago
Manager of Operations for Care Management Initiatives
About WellSense Health Plan:
WellSense Health Plan is a nonprofit health insurance organization dedicated to serving members across various states through Medicare, Individual and Family, and Medicaid programs. With a rich history of providing effective health insurance solutions, we prioritize the needs of our members in every aspect of our operations.
Position Overview:
In this pivotal role, reporting to the Manager of Care Management Operations, the Operations Manager will oversee the operational aspects of our care management initiatives. This includes ensuring compliance, program development, evaluation, and performance monitoring. The Operations Manager will be the key authority on the non-clinical operations of these programs.
Our Commitment to You:
- Flexible remote work options
- Competitive compensation packages
- Comprehensive benefits
Key Responsibilities:
- Ensure adherence to contractual and regulatory standards, maintaining accurate documentation for compliance.
- Analyze the implications of regulatory changes and propose necessary program adjustments.
- Lead and manage non-clinical operational activities of the Care Management teams, developing metrics to assess productivity and compliance.
- Facilitate team meetings and departmental discussions as needed.
- Identify and implement improvements to existing operational policies and procedures.
- Provide guidance to internal departments on non-clinical issues related to member services.
- Collaborate with clinical departments on matters requiring joint efforts.
- Act as the subject matter expert in cross-functional teams and projects.
- Proactively address and resolve programmatic challenges.
- Represent the programs in discussions with external auditors and regulatory bodies.
- Review and update non-clinical policies and workflows annually to ensure compliance and best practices.
- Work with the Medical Management team to uphold NCQA standards and contractual obligations.
- Prepare and deliver NCQA training for Care Management staff.
- Monitor performance metrics in collaboration with Finance.
- Develop and manage reports to evaluate departmental metrics and program effectiveness.
- Notify leadership of performance issues and collaborate on improvement strategies.
Qualifications:
- Bachelor's degree or equivalent experience in a health plan environment.
- Master's degree in a health-related field is preferred.
- Minimum of 5 years in healthcare or managed care settings.
- 5+ years of project or program management experience.
Skills and Attributes:
- Exceptional communication abilities, both written and verbal.
- Strong organizational skills with attention to detail.
- Ability to engage with various organizational levels and external stakeholders.
- Proven experience in leading cross-functional teams.
- Capacity to manage multiple complex projects independently.
- Proactive and collaborative team player.
- Strong analytical and problem-solving skills.
- Proficiency in Microsoft Office Suite.
Work Environment:
This position is primarily office-based with the flexibility to work remotely. The role requires regular attendance and engagement in a fast-paced environment.
About Us:
WellSense Health Plan is committed to diversity and inclusion, ensuring equal employment opportunities for all applicants. We participate in the E-Verify program to confirm employment eligibility.
