If you can run complex healthcare programs, keep vendors and stakeholders moving, and turn risk adjustment data into real operational wins, this role is for you. You’ll oversee provider engagement and reporting that impacts Medicare, Medicaid, and Commercial risk initiatives, with a heavy focus on execution, KPIs, and results.
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 coverage and services that work for members in real life, with an emphasis on access, quality, and outcomes.
Schedule
- Full-time
- Remote
- Compensation range: $77,000–$111,500 (may vary by geographic location)
What You’ll Do
- Coordinate risk adjustment program projects, including project plans, workflows, and timelines
- Track and communicate project status, deliverables, timeframes, and KPIs to stakeholders and leadership
- Evaluate provider-facing programs, processes, infrastructure, and reporting to identify improvements and drive performance
- Build relationships with provider relations teams and contracted provider organizations
- Support medical record retrieval for risk activities by leveraging provider relationships
- Manage day-to-day vendor operations tied to risk adjustment projects
- Partner with Risk Adjustment leadership, clinical teams, and financial analytics to identify focus areas and optimize performance across products
- Collaborate with analytics staff to improve reporting for KPI tracking and streamlined workflows
- Lead current-state assessments of provider organizations’ risk adjustment capabilities to identify performance gaps and opportunities
- Support additional responsibilities as assigned
What You Need
- Bachelor’s degree (required)
- Preferred: master’s degree in healthcare administration or related field
- 5–7 years of experience in healthcare project management and program implementation (or equivalent education/experience)
- Experience working in a highly regulated environment with compliance and quality outcomes
- Proven experience managing deadline-driven work and consistently meeting deadlines
- Preferred: familiarity with risk adjustment or related payer programs
- Preferred: understanding of value-based payment structures across Medicare, Medicaid, and Commercial products
- Preferred: health plan experience or experience managing programs in a provider office
- Preferred: experience implementing and operationalizing new programs
- Strong strategic thinking and ability to connect program decisions to business goals
- Strong ability to coordinate cross-functional teams and execute complex workflows
- Strong process improvement, analytical, and problem-solving skills
- Strong written and verbal communication skills across all levels
- Comfortable running meetings independently, setting agendas, and driving outcomes
- Strong Microsoft Office skills (Excel, PowerPoint, Outlook)
- Ability to work independently in a remote home-based environment
- Successful completion of pre-employment background check
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 risk adjustment exposure and you like leading programs where provider engagement and record retrieval are make-or-break, this is a strong remote lane with real impact across product lines.
Bring your project discipline, your provider relationship skills, and your KPI mindset, and help WellSense drive stronger risk performance across Medicare, Medicaid, and Commercial.
Happy Hunting,
~Two Chicks…