Operations Manager, Care Management Programs

WellSense Health Plan

7d•Remote

About The Position

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: Reporting to the Manager of Care Management Operations, the Operations Manager is responsible for documentation of care management processes and for providing operational oversight and analysis of our care management programs including compliance, program development, evaluation, and performance monitoring. This role assumes management of and accountability for the day-to-day non-clinical operations for these programs and is the subject matter expert for program operations. Our Investment in You: · Full-time remote work · Competitive salaries · Excellent benefits

Requirements

Bachelor’s degree or equivalent combination of education and relevant experience in a health plan setting required.
5+ years of healthcare/managed care experience.
5+ years project/ program management experience or other applicable work experience
Pre-employment background check
Exceptional written and oral communication skills.
Excellent organizational skills and attention to detail.
Ability to interact with all levels of the organization, as well as external stakeholders.
Superior meeting facilitation skills and experience in leading cross-functional teams
Demonstrated ability to work independently and manage multiple complex projects simultaneously.
Proactive, motivated, and a collaborative team player.
Demonstrated ability to adapt quickly to changing priorities.
Ability to analyze, compile, format, and present data to a variety of stakeholders.
Strong critical thinking, analytical, and problem-solving skills.
Proficiency with Teams and MS tools including Word, Excel, PowerPoint, Visio and MS Project
Demonstrated ability of managing competing priorities as well as stakeholders with differing objectives/perspectives.
Effective at forming alliances with other departments to develop partnerships and commitment toward completing the project.
Able to negotiate enterprise solutions with other departments that work interdepartmentally.

Nice To Haves

Master’s degree in Health-Related/Public Health field preferred.
Previous experience in Care Management strongly preferred.

Responsibilities

In collaboration with the Regulatory Program Manager, responsible for analyzing the impact of accreditation and regulatory changes and makes recommendations on programmatic operational changes to ensure compliance.
Develops, maintains, stores and communicates non-clinical policies, standard operating procedures and job aids for the CM department in collaboration with subject matter experts and business owners.
Annually reviews and updates non-clinical policies, standard operating procedures and workflows for needed revisions to meet model of care (MOC) changes; to ensure continued regulatory and contractual compliance; and to reflect best practices of care management.
Manages non-clinical operations for Care Management teams, including implementation of effective metrics to monitor productivity and compliance.
Serves as operations subject matter expert and leads workflows/processes and initiatives related to care management programs in collaboration with other business areas including but not limited to IT, UM, AG, Clinical Informatics, Quality, Public Partnerships, Marketing, Product and Transformation teams.
Liaison between IT and clinical to make system configuration and reporting changes including submitting requests and planning/ overseeing user acceptance/ regression testing.
In collaboration with the clinical care management leadership team, represents the CM programs in complex cross-functional teams and projects as the subject matter expert (internally and externally) on care management related matters.
Facilitates meetings and decision making as well as identifies scalability opportunities.
Identifies, communicates, and escalates issues to leadership on a timely basis.
Independently problem solves programmatic issues and implements appropriate solutions.
Supports clinical with audits from documentation preparation through operationalizing corrective action plans.
Liaison between clinical and reporting teams for development of standard reports to monitor and report on overall department metrics and care management program evaluation.
Accountable for tracking KPI metrics for care management goals and outcome targets where applicable and implementing operational changes in partnership with managers of care management as they relate to department metrics and clinical program performance.