WellSense Health Plan

Community Health Worker-Worcester/Springfield MA

WellSense Health Plan · Full Time · 3 hours ago

WellSense Health Plan

🌎 United States 💵 $27.64 - $40.14 per hour ⭐ 2-5 yrs exp 💼 Healthcare

The Community Health Worker performs outreach and assessments to coordinate community resources and safety net services for members. They advocate for access to healthcare, housing, and basic needs while collaborating with clinical staff to enhance care delivery.

insurance customer-service medical communication microsoft-office training counseling interviewing documentation time-management history compliance

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Sr. Provider Relations Consultant

WellSense Health Plan · Full Time · 10 days ago

WellSense Health Plan

🌎 United States 💵 $69500 - $101K per year ⭐ 5-10 yrs exp 💼 Others

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.

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Medical Director

WellSense Health Plan · Full Time · 15 days ago

WellSense Health Plan

🌎 United States 💵 $173K - $250K per year ⭐ 10+ yrs exp 💼 Healthcare

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.

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Clinical Auditor I

WellSense Health Plan · Full Time · 24 days ago

WellSense Health Plan

🌎 United States 💵 $64000 - $93000 per year ⭐ 2-5 yrs exp 💼 Finance

Perform detailed medical record audits of outpatient and professional claims to ensure accurate reimbursement and regulatory compliance. Identify billing discrepancies, analyze clinical data trends, and provide recommendations for audit improvements.

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Director of Sourcing & Supplier Management

WellSense Health Plan · Full Time · a month ago

WellSense Health Plan

🌎 United States 💵 $120K - $175K per year ⭐ 10+ yrs exp 💼 Others

Lead the strategic direction of the supplier procurement and management organization to optimize partner performance and value. Oversee the end-to-end supplier lifecycle, including selection, contracting, and regulatory compliance within a healthcare environment.

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Contract Manager

WellSense Health Plan · Full Time · 3 months ago

WellSense Health Plan

🌎 United States 💵 $77000 - $112K per year ⭐ 2-5 yrs exp 💼 Legal

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.

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Manager of Member and Provider Service

WellSense Health Plan · Full Time · 4 months ago

WellSense Health Plan

🌎 United States 💵 $69500 - $101K per year ⭐ 5-10 yrs exp 💼 Others

This role is primarily responsible for leading, coaching, and motivating a team of Member Services and Provider Services supervisors and staff, aiming to deliver high-quality, timely, and accurate service to members and providers. The manager will also analyze operational trends, monitor KPIs, and implement strategies to improve satisfaction and efficiency across service lines.

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