Operations Manager, Network Management

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.

Job Summary

The Operations Manager is responsible for overseeing the implementation, monitoring and integration of key projects, initiatives, programs and processes for Network Management. The Operations Manager advises, assists, and represents Network Management on a wide range of management, programmatic and operational issues and serves as liaison to various internal and external partners. Serving as a subject matter expert, the Operation Manager is responsible for key deliverables for various external regulatory bodies including regular mandatory reporting and regulatory survey readiness.

Our Investment In You

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

Key Functions/Responsibilities

• Assumes responsibility for the oversight of large-scale, high-impact projects spanning functional, divisional, and regional domains, including the development and operationalization of strategic plans/initiatives.
• Responsible for the development and management of Network Management training materials and policies and procedures.
• Engages in a close partnership with WellSense leaders to address Network Management requirements and mitigate risks, ensuring full compliance with multiple State and Federal Regulatory bodies.
• Monitors both internal and external changes impacting Network Management operations.
• Analyzes existing procedures and processes and may establish new procedures or recommend revisions as appropriate.
• Responsible for coordinating and completing deliverables for internal and external regulatory (i.e. MassHealth, CMS, DOI, Connector, NH DHHS, NCQA) audits and requests.
• Ensures updates and terminations for high profile providers are made in accordance with the Plan’s Standard Operating Procedures.
• Acts as the key contact for NCQA readiness, overseeing the interpretation and monitoring of quality standards related to Network Management.
• Regularly measures and monitors provider network adequacy via established standards and reports.
• Responsible for developing and maintaining database of required Network Management regulatory citations for use in provider contracts and provider manual.
• Supports the implementation/distribution of customized and ad hoc internal provider reports.
  
  

Supervision Exercised

• Does not supervise staff.
  
  

Supervision Received

• General supervision is received on a weekly basis
  
  

Qualifications

Education Required:

• Bachelor’s Degree in Health Care, Public Health Administration, Business, or a related field or the equivalent combination of education and relevant experience in a Network Management or managed care environment
  
  

Education Preferred

• Master’s degree is desirable
  
  

Experience Required

• Prior experience in Network Management or Managed Care
  
  

Experience Preferred/Desirable

• 5 or more years of related Network Management experience is preferred
  
  

Required Licensure, Certification Or Conditions Of Employment

• Successful completion of pre-employment background check
  
  

Competencies, Skills, And Attributes

• Demonstrated effective Project Management Skills are necessary.
• A strong attention to detail.
• Strong oral and written communication skills; ability to interact at all levels.
• Ability to maintain confidentiality and communicate with tact and discretion.
• A strong working knowledge of Microsoft Office.
• Proven ability to learn new software applications and become proficient using them.
• Ability to work as a team member as well as independently, manage multiple tasks, be flexible and possess excellent organizational skills.
• Demonstrated ability to meet critical deadlines.
• Effective time management skills.
  
  

Working Conditions And Physical Effort

• Ability to work outside of normal business hours during peak periods.
• Regular and reliable attendance is an essential function of the position.
• This job is performed in a typical remote home office environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.
  
  

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 is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

Required Skills

Required Experience