The Staff Accountant is a key member of the Accounting team and works closely with all members of the team in meeting close deadlines, working with various general ledger modules, preparing account reconciliations, and supporting internal and external audits. Positive and team oriented work ethic is critical to this role. Our Investment in You Full time remote work Compet

Reporting to the VP, ACA & Commercial Product Management, Public Plans division, the Product Manager serves as the business lead for ACA product operations and project execution as well as end to end management to bring new products and services to market. The Product Manager plays a key role in the development and execution of strategic initiatives to support market comp

Responsible for the daily supervision and operations of the Prior Authorization Specialists. Develops training, trains staff, assigns work, implements policies and procedures, and resolves complex issues to ensure accurate and timely management of prior authorization requests. Maintains compliance with state and federal requirements. Performs quality assurance audits. Imp

Uses SAS and/or SQL coding to pull claims and membership data to support involved healthcare analytics Supports the development of effective medical management programs/initiatives through analyzing, monitoring, and reporting the effectiveness of these programs Develops and implements plans to measure and report on corporate wide health care delivery cost and utilization

The Operations Reporting and Performance Analyst (ORPA) plays an essential role in improving organizational effectiveness by analyzing operational data and identifying opportunities for learning and development. The OPRA collects and analyzes data to assess performance metrics, identifies training needs, and implements strategies to improve employee performance and skill

The WellSense Health Plan Manager of Hospital and Physician Contracts is responsible for the development, implementation and management of a cost effective provider network, maintaining complex and geographically diverse contracts. The Manager leads a team of Hospital and Physician Contract Managers and is responsible for the development of network wide strategies to impr

Manages a panel of high risk, medically, behaviorally and socially complex members Administer Comprehensive Assessment, medication reconciliation, convene local care teams, develop, document, and implement integrated care plans Completes timely initial and on going face to face comprehensive assessments with Member to evaluate member's medical, behavioral health, function

The Manager of Healthcare Analytics is responsible for financial analysis, measurement, and contract compliance as it relates to WellSense's Clinical Vendors. Working closely with Finance leadership, clinical leadership, and leaders from WellSense's Clinical Vendors, the Manager will ensure the financial integrity of these partnerships by leading the development and commu

The WellSense Plan Manager of Ancillary Contracts is responsible for the development, implementation and management of a cost effective provider network, maintaining complex and geographically diverse contracts. Serves as mentor and manage o Ancillary Contract Managers, leading in the development of network wide ancillary strategies to improve efficiencies and access. Und

Position Health Data Analyst III (2 positions available) Location Charlestown (Boston), MA. Report to main office in Charlestown, MA. Eligible to work remotely from anywhere in the U.S. but must work from a state the employer is legally eligible to employ Alabama, Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland

Under the direction of the Vice President of the Senior Vice President of Behavioral Health, the Senior Director of BH Clinical Programs oversees the BH Care Management, BH Utilization Management and Clinical Programming teams. The Senior Director develops and integrates the strategies to enhancing the quality of care for patients, satisfaction, healthcare outcomes in a c

The Operations Trainer role is pivotal in elevating new and existing employee's performance and capabilities through classroom and virtual training sessions. The role primarily supports Health Plan Operations departments such as Member and Provider Service, Claims, Member Enrollment, and Provider Appeals. The Operations Trainer will also conduct job specific training, inc

Leads the rate development process by providing analyses and recommendations on benefit design, rating factors, trend picks, and projection of future claim cost. Oversees regulatory rate filings and prepares data or response for additional inquiries. Leads the development of monthly IBNR reserve estimates for different line of business. Oversees monthly accruals and contr

Strategy and Vision Contribute to the development and articulation of a comprehensive AI/ML and automation strategy aligned with the overall business objectives, with a particular focus on end to end data quality, specifically in the areas of health equity and encounters. Execute the vision for AI/ML and automation technologies, ensuring alignment with industry trends and

The Licensed Behavioral Health Clinician provides care management services at facilities, in the community and telephonically for WellSense members receiving behavioral health (BH) and substance use services. The Licensed Behavioral Health Clinician works alongside medical Utilization Management and medical Care Management staff, pharmacists, and medical directors as part