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

Reporting to the Director of BH and LTSS Network Strategy, in this highly visible role, the Manager of Behavioral Health Network is responsible for contracting the entire BH Network for the Medicare, Medicaid and Commercial suite of products across multiple states. The Manager of BH Network will be a central point of contact for the BH Network. Will enable a high performi

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

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 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

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

Our Event Manager plays a key role in maintaining WellSense's commitment to community as a remote organization. In this role, you will plan, coordinate and execute WellSense organizational events for 1000+ employees as well as meetings and events at the team or department level. Partnering with leaders, you will gain insight into the goals or objectives of each event. Res

The Business Encounter Data Analyst is responsible for compiling and analyzing encounter data and understanding the claim impact of changes and decision to the business process to ensure that CMS and State Service Level Agreements (SLAs) are achieved. This individual will support the encounter data lifecycle process working closely with business and technical resources as

Monitors actual FCR and NPS performance against corporate targets; presents findings; proactively investigates and communicates explanations for variation and conducts root cause analysis. Provides critical data analysis and recommendations to establish corporate goals related to FCR and NPS. Conducts deep analysis on data related to FCR and NPS, reviews member surveys, l