Help drive clinical excellence and regulatory compliance across WellSense’s Medicaid and Medicare programs by leading quality improvement initiatives that directly impact member outcomes.
About WellSense Health Plan
WellSense is a nonprofit health plan serving more than 740,000 members across Massachusetts and New Hampshire. With more than 25 years of service, we provide accessible, high-quality health plans for Medicare, Medicaid, and Individual/Family members. Our mission is simple: deliver healthcare that works for every member, regardless of circumstance.
Schedule
• Full-time
• Fully remote
• Occasional travel for meetings or state-level quality sessions
• Cross-functional collaboration with clinical, operational, and analytics teams
What You’ll Do
• Serve as a subject matter expert for quality management across medical and behavioral health programs
• Lead the development and execution of corporate quality initiatives aligned with NCQA and state regulatory requirements
• Oversee quality improvement needs across all products in assigned regions (MA and/or NH)
• Chair workgroups and committees that track progress on corporate and regulatory quality initiatives
• Ensure compliance with contractual requirements from EOHHS, DHHS, EQRO, NCQA, and other regulatory bodies
• Develop detailed project plans, timelines, metrics, and outcome measures for performance improvement projects
• Facilitate large multidisciplinary teams to implement targeted quality interventions
• Prepare internal and external documentation, reports, and regulatory submissions
• Work closely with analytics teams to define data needs, analyze trends, and support quality decision-making
• Liaise with vendors to ensure accurate reporting and data integration
• Respond to regulatory inquiries and represent the plan at state quality meetings
• Identify improvement opportunities using internal and external data sources
• Manage day-to-day quality processes including document review, literature searches, and independent decision-making
• Ensure timely submission of all quality and regulatory deliverables
• Other duties as assigned
What You Need
• Bachelor’s degree in Nursing, Health Administration, or related field (or equivalent experience)
• Master’s degree in Social Work, Behavioral Health, Public Health, or related field preferred
• 5+ years of progressive experience in healthcare or managed care
• Strong knowledge of clinical quality management, quality improvement methodologies, and regulatory standards
• Experience working with Medicaid/Medicare populations preferred
• NCQA experience strongly preferred
• Project development or health policy experience a plus
• Lean Six Sigma or CPHQ training preferred
Benefits
• Competitive salary
• Full medical, dental, vision, and pharmacy coverage
• Flexible Spending Accounts
• Paid time off and wellness resources
• 403(b) retirement plan with employer match
• Career development and advancement opportunities
• Remote work with strong team support
If you’re ready to lead impactful quality initiatives and help shape better outcomes for vulnerable populations, this role is your next step.
Happy Hunting,
~Two Chicks…