If you know how to turn quality data into real-world improvement, this role puts you at the center of it. You’ll lead Medicare STARS and broader quality initiatives, driving compliance, stronger outcomes, and measurable performance gains across the health plan.
About WellSense Health Plan
WellSense Health Plan is a nonprofit insurer serving members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. With a long-standing mission to provide coverage that works for members in all circumstances, WellSense focuses on access, outcomes, and health equity through a growing regional footprint.
Schedule
- Full-time
- Remote
- Salary range: $77,000–$111,500 (may vary by geographic location)
What You’ll Do
- Develop and implement quality improvement strategies aligned with organizational goals and regulatory requirements (NCQA, CMS, state regulators)
- Analyze clinical and operational data to identify trends, gaps, and improvement opportunities
- Lead root cause analyses and corrective action plans for identified issues
- Monitor and report on KPIs including state-specific quality measures, HEDIS, CAHPS, and Medicare STARS-related performance
- Collaborate with provider groups to review performance data, identify barriers, and implement targeted interventions
- Support accreditation and compliance activities, including coordinating submissions and ensuring timely, accurate reporting
- Build project plans and timelines for performance improvement projects and ongoing evaluation
- Lead workgroups and multidisciplinary project teams to drive targeted quality initiatives
- Collaborate with external vendors on quality projects and monitor vendor performance
- Participate in state quality meetings and partner with state leaders and internal stakeholders on initiatives
- Conduct literature reviews to support evidence-based quality improvement work
- Perform other related duties as assigned
What You Need
- Bachelor’s degree in nursing, health administration, behavioral health, public health, or related field (Master’s preferred)
- 5+ years of experience in healthcare quality improvement, preferably within a health plan
- Strong knowledge of managed care regulations, NCQA standards, HEDIS measures, and CMS Stars
- Strong data analysis skills and ability to translate insights into action
- Experience with quality improvement methodologies and performance measurement tools
- Strong leadership, communication, and project management skills
- Ability to lead cross-functional teams and large-scale projects
- Provider collaboration experience (preferred)
- Preferred certifications: CPHQ, Lean Six Sigma, or Project Management
Benefits
- Full-time remote work
- Competitive salary
- Medical, dental, vision, and pharmacy benefits
- Flexible Spending Accounts (FSA)
- 403(b) with savings match
- Paid time off
- Career advancement opportunities
- Resources to support employee and family wellbeing
If you’ve been looking for a remote role where quality isn’t just a report, it’s a strategy, this is a strong one to move on.
Bring your STARS and HEDIS expertise, your project leadership, and your ability to rally stakeholders, and help WellSense improve outcomes at scale.
Happy Hunting,
~Two Chicks…