It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The Manager of Community Partners (CP) program is responsible for the overall coordination, assignment and performance management of contracted Behavioral Health (BH) and Long-Term Services and Supports (LTSS) Community Partners providers for the WellSense Accountable Care Organization (ACO) and Managed Care Organization (MCP) programs. The Manager supervises WellSense CP program staff and ensures that the operations of the program interfaces with ACO and CP key stakeholders to support Boston Medical Center Health System (BMCHS) organizational goals.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Responsible for oversight of CP program operations in alignment with established operational, clinical and regulatory goals and standards in collaboration with the Director, Community Partners Program
• Serves as or identifies the designee to serve as the MCO key point of contact for all ACO partners specific to administrative and clinical support for the CP program as to ensure that assigned high risk members with behavioral health or long-term services and supports needs are managed effectively within the system, meeting with the appropriate ACO clinical leadership regularly as appropriate
• Ensures compliance with contractual and regulatory requirements and standards
• Participates in development and implementation of key program initiatives to improve integration of CPs into primary care
• Serves as the primary liaison to finance and technical departments specific to CP operations, ensuring processes for file exchange and payment oversight and rapid resolution of identified problems are in place through coordination with key stakeholders (including leadership)
• Ensures that health plan and ACOs has payment and performance strategies deployed appropriately and in line with EOHHS requirements and ACO/ MCO priorities, and that effective oversight constructs are in place and being utilized such that monitoring of environmental trends is taking place
• Supervises staff to ensure that CP related projects are managed across organizations or departments
• Leads health plan CP efforts as liaison to and from the ACOs, MCO, BH vendor/ Material Subcontractor and CPs
• Interfaces with EOHHS around CP and ACO performance specific to implementation and maintenance of contractual Documented Processes
• Facilitates ongoing communication between Plan Care Management and the CPs
• Plans and facilitates performance meetings with BH Material Subcontractor, ACO and CPs as appropriate and as contractually required
• Ensures all reporting requirements from BH vendor/Material Subcontractor and BH CPs are accurate and timely, and resolves any error issues or updates related to EOHHS deliverables
• Tracks improvement requests from EOHHS
• Facilitates resolution of CP clinical and operational issues, coordinating with BH vendor/ Material Subcontractor, ACO, MCO SMEs and CPs as necessary
• Leads CP provider focused initiatives with BH vendor/ Material Subcontractor, Clinical and Provider Relations teams
• Implement new requirements as outlined by EOHHS with the CPs
• Manages the activities of complex work processes to achieve program goals including but not limited to ensuring that the ACO, MCO and CP provider is meeting contractual, regulatory and accreditation requirements
• Managing, tracking and resolving day to day issues for ACOs, MCO and CP Providers
• Manages the CP / MCO Agreement for each ACO as applicable
• Monitors network adequacy, if applicable
• Works with the Director of BH Programs and Strategy, the BH Material Subcontractor and ACO Community Partner / Population Health leadership to review available data and identify trends that may need to be addressed
• Leads ongoing meetings (e.g. Operations) with Plan staff and CP staff
• Manages a team of 3-5

Qualifications:

Education:

• Bachelor’s degree in Psychology, Social Work, Health Care Administration, Public Health, Nursing, Social Work or related field

Preferred/Desirable:

• Master’s degree in a related field preferred

Experience:

• 3-5 years supervisory/management experience
• 3+ years healthcare/managed care experience (specifically Provider Relations, UM, claims quality and/or project/program management)
• Experience with Medicaid recipients and community services

Preferred/Desirable:

• 2+ years’ experience with the MA Community Partners Program
• Proficiency with Microsoft Office, in particular Excel, and other data entry processing applications

Competencies, Skills, and Attributes:

• Detail oriented, excellent proof reading and editing skills
• Demonstrated ability in facilitating cross-functional teams
• Demonstrated ability to work independently and manage multiple projects simultaneously
• Excellent organizational and project management skills
• Demonstrated commitment to excellent customer service
• Understands services to diverse member populations
• Effective collaborative and proven process improvement skills
• Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts
• Demonstrated ability to successfully plan, organize, implement and manage projects within a health care setting
• Strong analytical and problem solving skills

Working Conditions and Physical Effort:

• Up to 25% travel required

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

• WellSense will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.