by Terrance Ellis | Nov 20, 2025 | Uncategorized
Use your clinical expertise to protect members, elevate care quality, and ensure fair outcomes for behavioral health and substance use appeals and grievances.
About WellSense Health Plan
WellSense is a nonprofit health insurance plan serving more than 740,000 members across Massachusetts and New Hampshire. For over 25 years, we’ve delivered accessible Medicare, Medicaid, and Individual/Family plans designed to support people through every circumstance. Our mission is simple: health coverage that works for everyone.
Schedule
• Full-time, remote role
• Standard business hours with cross-functional collaboration
• Occasional travel required
What You’ll Do
• Audit medical necessity appeal decisions to ensure accuracy, compliance, and clinical soundness
• Support grievance intake, investigation, and resolution; identify trends and improvement opportunities
• Ensure timely resolution of clinical appeals, administrative appeals, and grievances
• Assist with correspondence to members and providers
• Provide coaching and performance feedback to staff based on quality trends
• Lead and participate in calibration sessions to maintain consistency and accuracy in audit standards
• Recommend and document process enhancements that improve quality and compliance
• Identify workflow defects, inconsistencies, and risk areas
• Maintain deep knowledge of internal policies, regulatory requirements, and accreditation standards
• Serve as subject matter expert on behavioral health and substance use topics
• Collaborate with cross-functional partners across Appeals, Grievances, Clinical, and Quality teams
• Support regulatory reporting, universe preparation, and audit presentation
• Perform additional duties as assigned
What You Need
• Registered Nurse with an active, unrestricted RN license
• Associate or Bachelor’s degree in Nursing, or a Diploma in Nursing
• 3+ years of managed care healthcare experience
• Strong foundation in behavioral health, substance use, crisis intervention, and psychopharmacology
• Experience with payer medical guidelines, including MCG and/or InterQual
• Working knowledge of psychiatric and addiction treatment protocols
• Familiarity with BH inpatient/outpatient settings, interdisciplinary treatment teams, and continuum of care
• Strong communication, organization, de-escalation, and problem-solving skills
• Excellent analytical ability and comfort interpreting metrics and data
• Proficiency with Microsoft Office
• Experience working with diverse populations
• Bilingual candidates encouraged to apply
Preferred
• BSN
• ANCC Certification in Psychiatric–Mental Health Nursing
• Prior psychiatric nursing or substance use treatment facility experience
• Knowledge of Medicare/Medicaid regulations and NCQA requirements
Benefits
• Competitive salary range: $69,500–$100,500 (adjusted by geography and experience)
• Full medical, dental, vision, and pharmacy coverage
• 403(b) with employer match
• Merit increases and advancement opportunities
• Flexible Spending Accounts
• Paid time off
• Wellness resources for employees and families
Join a mission-driven care team improving outcomes for members who need strong behavioral health advocacy the most.
Happy Hunting,
~Two Chicks…
by Terrance Ellis | Nov 20, 2025 | Uncategorized
Help ensure members receive fair, timely, and compliant resolutions to their appeals and grievances while supporting a mission-driven health plan dedicated to equitable care.
About WellSense Health Plan
WellSense is a nonprofit health insurance plan serving more than 740,000 members across Massachusetts and New Hampshire. For over 25 years, we’ve delivered dependable Medicare, Medicaid, and Individual/Family coverage designed to meet people where they are. We’re committed to fairness, accessibility, and high-quality service for every member.
Schedule
• Full-time, remote
• Standard business hours
• Collaboration across Appeals, Grievances, Clinical, and Compliance teams
Responsibilities
Appeals
• Process member medical and pharmacy appeals across internal teams and external vendors
• Create appeal schedules and determine case-by-case processing guidelines
• Ensure compliance with CMS, MassHealth, DHHS, and other regulatory requirements
• Serve as liaison with IRE, QIO, Medicaid Fair Hearing Boards, and other oversight entities
• Maintain compliance with Qualified Health Plan and commercial plan regulations
• Support NCQA accreditation standards through documentation and process adherence
• Participate in appeals audits and recommend improvements
• Draft and issue appeal determination letters
• Communicate results with members, providers, and medical personnel
• Prepare reports, research case data, and ensure documentation accuracy
• Assist with required reporting to regulatory agencies
Grievances
• Coordinate complaint and grievance investigations with internal teams and vendors
• Collaborate with clinical staff on quality-of-care grievance reviews and action plans
• Respond to member concerns, complete investigations, and issue resolution letters
• Maintain compliance with regulatory guidelines and documentation standards
• Identify trends and partner on improvement plans across departments
Requirements
Education
• Bachelor’s degree in Healthcare Administration or related field
• Equivalent experience may be considered
Experience
• 2+ years in a managed care organization
• Required experience with Medicare medical/pharmacy prior authorizations, appeals, and grievances
• Strong understanding of CMS, MassHealth, DHHS, and NCQA guidelines preferred
• Conflict resolution experience highly preferred
Skills
• Strong project management and organization skills
• Excellent verbal and written communication
• Independent decision-making and critical thinking
• Proficiency in Microsoft Office
• Ability to collaborate with diverse internal teams and member populations
• Detail-oriented and customer-service focused
• Bilingual candidates encouraged to apply
Benefits
• Full-time remote work
• Competitive salary
• Comprehensive benefits package
• Opportunities for advancement within a mission-driven organization
Make a real impact by helping members receive fair and compassionate resolutions during their most important moments.
Happy Hunting,
~Two Chicks…
by Terrance Ellis | Nov 20, 2025 | Uncategorized
Help shape smarter, more equitable healthcare by delivering analytics that drive pricing, forecasting, and financial stability for members who depend on WellSense.
About WellSense Health Plan
WellSense is a nonprofit health insurance plan serving more than 740,000 members across Massachusetts and New Hampshire. For over 25 years, we’ve delivered high-quality, affordable health coverage for Medicare, Medicaid, and Individual/Family plans. Our mission is simple: provide health insurance that works for people, no matter their circumstances.
Schedule
• Full-time, remote
• Standard business hours
• Collaboration across actuarial, finance, and analytics teams
What You’ll Do
• Analyze financial, statistical, and mathematical data to support pricing, forecasting, and medical economics
• Develop premium rates using benefit design, claims experience, regulatory mandates, rating factors, and projected future claim cost
• Prepare regulatory rate filings and respond to follow-up inquiries
• Produce monthly IBNR reserve estimates across multiple lines of business
• Prepare monthly financial accruals and contract settlements
• Support budgeting, reforecasting, and financial projections
• Assist with risk adjustment analytics and risk score modeling
• Perform trend analysis and provider contract analytics
• Maintain recurring reports for internal teams and regulatory requirements
• Extract and validate data using SQL/SAS queries
• Summarize findings, document processes, and contribute to audits
• Provide analytic support for cross-department initiatives
• Participate in the Actuarial Student Program and progress toward ASA/FSA
What You Need
• Bachelor’s degree in Mathematics, Actuarial Science, Finance, Economics, or related field
• At least 2 years of actuarial analysis, data modeling, or related analytics experience
• Strong SQL and SAS (or similar statistical software) skills
• High proficiency in Excel and Microsoft Office
• Completion of at least 3 SOA exams preferred
• Experience in managed healthcare or insurance operations preferred
• Ability to manage deadlines, multitask, and solve complex problems
• Strong communication skills and a collaborative mindset
Benefits
• Full-time remote work
• Competitive salary
• Excellent healthcare benefits
• Professional development support, including actuarial exam progression
• Opportunities for growth within a mission-driven organization
Help build a healthier future with a team committed to equity, accuracy, and impact.
Happy Hunting,
~Two Chicks…
by Terrance Ellis | Nov 20, 2025 | Uncategorized
Help families receive the care they depend on by ensuring accurate and timely insurance collections.
About Aveanna Healthcare
Aveanna Healthcare is one of the nation’s largest providers of home care for medically fragile patients. We support thousands of families through compassionate, reliable care delivered with integrity and excellence. Our mission drives everything we do, and every team member plays a vital role in helping patients receive the services they need.
Schedule
• Full-time, remote
• Monday–Friday
• Must be able to work in a high-volume environment
• Reliable internet and quiet workspace required
What You’ll Do
• Process a minimum of five claims per hour with accuracy
• Manage a portfolio of payers, including collections, aging, and denial follow-up
• Research, resolve, and convert claim denials
• Maintain updated payer rules and support billing teams
• Perform month-end reconciliations and assist cross-functional departments as needed
• Meet daily, monthly, and quarterly collection goals
• Ensure all work complies with internal policies and external regulations
What You Need
• High school diploma or GED
• Minimum two years of medical insurance collections experience
• Proficiency with Microsoft Outlook, Word, and Excel
• Strong math and basic accounting knowledge
• Proven ability to work efficiently in a high-call-volume environment
Benefits
• $19.00–$22.00 per hour
• Health, dental, vision, and life insurance options
• 401(k) with employer match
• Employee Stock Purchase Plan
• 100% remote role
• Weekly pay
• Opportunities for career advancement
Take the next step toward a stable, rewarding remote role that supports families across the country.
Happy Hunting,
~Two Chicks…
by Terrance Ellis | Nov 20, 2025 | Uncategorized
Bring joy to virtual wedding guests and help couples celebrate with creativity and connection.
About Wedfuly
Wedfuly creates unforgettable, highly produced virtual wedding experiences that allow couples to share their big day with loved ones anywhere in the world. Now part of Wedgewood Weddings, we’re expanding our mission with even more support behind each celebration. Our team is proudly inclusive and welcomes talent from all backgrounds, identities, and lived experiences.
Schedule
• Part-time role
• Weekend and holiday availability required
• Remote work
• Consistent, high-speed internet needed (5 Mbps+ upload)
Responsibilities
• Host and MC virtual wedding livestreams using upbeat, engaging communication
• Follow the wedding timeline with accuracy and professionalism
• Start, monitor, and coordinate all livestream logistics
• Welcome, guide, and support virtual guests throughout the event
• Troubleshoot tech issues and provide real-time assistance
• Collaborate with the Wedfuly AV team and onsite contacts to ensure seamless execution
• Offer constructive input to help improve workflows and the guest experience
• Work independently while managing dynamic, fast-moving events
• Delegate tasks to team members when needed
Requirements
• Weekend and holiday availability
• Reliable Apple laptop, external monitor, and fast home internet
• Strong MacOS skills; comfortable with Zoom, Slack, Airtable, Dropbox, Intercom, and Google Workspace
• Ability to stay calm and clear-headed in high-pressure moments
• Excellent attention to detail and time management
• Outgoing, personable, and comfortable speaking to diverse groups
• Ability to multitask and pivot quickly
• Takes initiative, ownership, and brings a “can-do” attitude
Benefits
• $17/hr
• Fully remote
• Creative, meaningful work that connects families and friends
• Opportunity to grow skills in hosting, production, and virtual events
Happy Hunting,
~Two Chicks…
by Terrance Ellis | Nov 20, 2025 | Uncategorized
Help couples share their wedding day with loved ones everywhere through seamless, high-quality livestreams.
About Wedfuly
Wedfuly creates immersive virtual wedding experiences, giving couples a meaningful way to include every guest regardless of distance, budget, or life circumstance. Now part of Wedgewood Weddings, we’re growing our ability to serve couples with creativity, care, and world-class support. Our team is proudly inclusive and celebrates diversity across all identities.
Schedule
• Contract 1099 role
• 10–20 hours weekly
• Weekend availability required (Friday–Sunday)
• Variable schedule based on wedding bookings
• Fully remote, with optional onsite opportunities
What You’ll Do
• Translate client wedding specs into a complete AV plan and livestream setup
• Lead pre-wedding AV calls to test audio, camera placement, and connectivity
• Operate multimedia and sync all AV queues with Zoom during live events
• Play and manage wedding music via Spotify during the livestream
• Coordinate remotely with onsite contacts to guide tech setup
• Troubleshoot AV issues in real time and ensure smooth livestream production
• Provide tech support to virtual guests and partner closely with the wedding host
• Communicate with DJs, musicians, and venues about connectivity and audio needs
• Improve internal AV processes, equipment, and workflows
• Research livestream trends and apply new learnings
• Optional: Attend select weddings onsite to set up and operate gear
What You Need
• 10–20 weekly hours with mandatory weekend availability
• Reliable Apple laptop, external monitor, and fast internet (5 Mbps+ upload)
• Strong MacOS skills and high proficiency with Zoom
• Experience with OBS preferred
• AV experience required; hybrid event experience a plus
• Familiarity with iPhones, Androids, mixers, Bluetooth devices, and event audio
• Excellent organization and attention to detail
• Ability to explain AV concepts clearly to non-technical users
• Customer-service mindset, strong communication skills, and upbeat energy
• Ability to stay calm, flexible, and solution-oriented during live events
Benefits
• $20/hr
• Fully remote contract role
• Meaningful, creative work helping couples celebrate with loved ones
• Hands-on experience in livestream production and event AV
Love live production and want to help create unforgettable moments? Apply now.
Happy Hunting,
~Two Chicks…
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