If you’re the person who can run a quality program like a project manager and think like an analyst, this role is built for you. You’ll lead HEDIS and quality performance work from planning through execution, keep data clean and defensible, and drive measurable results tied to regulatory and accreditation requirements.
About WellSense Health Plan
WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. They focus on delivering health coverage and services that work for members in real life, with a strong commitment to quality, equity, and outcomes.
Schedule
- Full-time
- Remote
- Compensation range: $77,000–$111,500 (may vary by geographic location)
What You’ll Do
- Lead quality performance projects end-to-end, including timelines, deliverables, and outcome tracking
- Coordinate cross-functional collaboration to keep initiatives aligned with regulatory and organizational goals
- Analyze performance data, trends, validation findings, issue logs, and predicted outcomes to guide decisions and execution
- Develop and implement validation strategies to ensure data accuracy and reliability
- Manage milestones, stakeholder engagement, and timely data submissions
- Partner with internal teams to ensure unbiased HEDIS results, including variance research, data mapping, and supplemental source review
- Monitor quality measure updates (including ECDS) and assess impact on data collection, reporting, and performance
- Support provider engagement to align on quality metrics, documentation standards, and supplemental data capture
- Develop recommendations through research and analysis tied to quality improvement data (population health, health equity accreditation, and related initiatives)
- Oversee vendor management for chart retrieval services, including deliverable tracking, invoice processing, and contract negotiations
- Contribute to provider tools and education materials related to HEDIS measures and HEDIS-relevant ICD-10/CPT coding aligned with NCQA requirements
- Support systems and processes that enable year-round care gap closure and supplemental data operations
- Complete other related projects as assigned
What You Need
- Bachelor’s degree in healthcare, public health, health administration, or related field (or equivalent experience)
- 4+ years of experience in healthcare quality, managed care, or project management
- Knowledge of NCQA HEDIS supplemental and administrative data processes and source requirements
- Strong understanding of healthcare performance measures and member-level data (HEDIS, Medicare Stars, Marketplace, PQA, Medicaid measures)
- Ability to translate clinical and technical information clearly for different audiences
- Strong troubleshooting, analytical, and problem-solving skills with the ability to communicate solutions
- Ability to work with minimal supervision and lead collaboration with stakeholders and vendors
- Preferred: master’s degree in public health, healthcare administration, or related field
- Preferred certifications: PMP, Lean Six Sigma, or CPHQ
- Preferred technical experience: SQL, SAS, MS Access reporting, and working with enterprise data warehouses
- Preferred tools: Inovalon and other HEDIS reporting software (QSI-XL certified tools, QMRM, iPORTHD)
- Preferred: experience with internal data cleansing and reconciliation (extract, analyze, interpret trends/variances)
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
- Merit increases
- Career advancement opportunities
- Employee and family wellbeing resources
If you’ve got the mix of HEDIS knowledge, data integrity instincts, and project leadership to keep quality work moving without surprises, this is a strong remote role to pursue.
Bring your systems thinking, your validation mindset, and your ability to drive cross-team execution, and help WellSense raise performance with clean, defensible results.
Happy Hunting,
~Two Chicks…