WellSense Health Plan

The HR Program Manager oversees a portfolio of cross-functional HR initiatives and partnerships to achieve sustainable organizational outcomes. This includes designing HR programs, optimizing processes, and ensuring compliance with Medicaid and Medicare contracts.

Manage a territory of healthcare providers to enhance relationships and serve as the primary liaison between providers and internal departments. Lead provider education initiatives, conduct orientations, and ensure contractual compliance with state and NCQA regulations.

The Medical Director provides clinical oversight for utilization management, conducting medical necessity reviews and managing appeals and grievances. They collaborate with healthcare providers and committees to improve population health outcomes and lower the overall cost of care.

The Contract Manager facilitates the development, implementation, and management of cost-effective provider networks while leading contract language and reimbursement negotiations. They also ensure provider compliance with regulatory standards and analyze network performance to improve cost and quality outcomes.