WellSense Health Plan · 23 hours ago
Risk Adjustment Performance Manager
United States
Full-time
Remote
Mid, Senior Level
$77K/yr - $112K/yr
5+ years expWellSense Health Plan is a growing regional health insurance company with a 25-year history of providing health insurance that works for our members. The Risk Adjustment Performance Manager will manage and monitor operational activities within the risk adjustment department, establish project KPIs, and collaborate with internal and external stakeholders to ensure successful program outcomes.
Hospital & Health Care
Responsibilities
Coordinate risk adjustment program projects including developing project plans, workflows and timelines
Track and communicate project status, timeframes, deliverables, and KPIs to multiple stakeholders and department leadership
Perform ongoing evaluations of provider-facing programs, processes, infrastructure, and reporting to pinpoint areas for improvement and drive changes that maximize program performance and impact
Build relationships with provider relations teams and provider offices
Support retrieval of medical records for risk activities by leveraging relationships with providers and provider relations teams
Manage day to day operations of vendors associated with risk adjustment department projects
Partner with Risk Adjustment Leadership, Clinical, and Financial Analytics teams to define opportunities and areas of focus to optimize risk adjustment performance across all products and drive solutions
Partner with analytics staff to identify reporting opportunities that will assist in KPI tracking and streamlined workflows
Lead current-state assessments of provider organizations’ risk adjustment capabilities to evaluate performance and identify improvement opportunities
Other duties as assigned
Qualification
Required
Bachelor's Degree
Minimum of 5-7 years' experience in health care project management and program implementation or equivalent education
Experience in a highly regulated setting with a focus on compliance & quality outcomes
Experience having deadline driven work & meeting those deadlines
Successful completion of pre-employment background check
Ability to think strategically and understand how program decisions impact overall business goals
Ability to coordinate cross functional teams to execute complicated workflows and tasks
Effective collaborative and proven process improvement skills
Strong oral and written communication skills; ability to interact within all levels of the organization
Demonstrated ability to successfully plan, organize and manage projects
Act like an owner, be self-driven and own the results
Ability to run meetings independently as needed and create agendas that tie back to results
Strong analytical and problem solving skills
Ability to work independently in a remote home based environment
A strong working knowledge of Microsoft Office products (Excel, PPT, Office, Outlook)
Preferred
Masters Degree – Healthcare administration or related field
Familiarity with risk adjustment or related healthcare payer programs preferred
Understanding of value based payment structures across various products (Medicare, Medicaid, Commercial)
Health Plan experience or experience managing programs within a providers office
Experience implementing and operationalizing new programs
Benefits
Medical
Dental
Vision
Pharmacy
Merit increases
Flexible Spending Accounts
403(b) savings matches
Paid time off
Career advancement opportunities
Resources to support employee and family wellbeing
Company
WellSense Health Plan
A nonprofit health plan serving Medicare, Individual & Family, and Medicaid plan members in Massachusetts & New Hampshire.
1001-5000 employees
H1B Sponsorship
WellSense Health Plan has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (1)
2024 (8)
2023 (2)
2021 (2)
2020 (1)
Funding
Current Stage
Late StageLeadership Team
Heather Thiltgen
President & CEO
Diana Cruz
Chief Operating Officer
Company data provided by crunchbase