Job Description

 

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

 

Job Summary:

The Manager of Healthcare Analytics is responsible for financial analysis, measurement, and contract compliance as it relates to WellSense’s Clinical Vendors. Working closely with Finance leadership, clinical leadership, and leaders from WellSense’s Clinical Vendors, the Manager will ensure the financial integrity of these partnerships by leading the development and communication of value added analytics and reporting while ensuring data quality and integrity.

Our Investment in You:

• Full-time remote work

• Competitive salaries

Excellent benefits

 

Key Functions/Responsibilities:

• Maintain financial relationships with Clinical Vendors responsible for managed care benefits. Assist with negotiations of revised and new financial terms as needed to support WellSense growth strategy.
• Responsible for analyses to support business case for outsourcing versus insourcing and evaluating opportunities, risks, and ROI. Clearly define and calculate baseline costs for developing financial targets. Measure outcomes and continually evaluate the business case for outsourcing versus insourcing.
• Assess impact on claims costs and utilization; evaluate risk sharing and VBP options. Assist in developing cost target and objectives to drive negotiations.
• Collaborate in RFP development; ensure scope and timeliness of services clearly defined so efficiencies and savings can be achieved. Seek to leverage value-adds from the vendor that will increase efficiencies to the organization.
• Develop, maintain, and communicate key metrics and reports for each Clinical Vendor, highlighting areas for opportunity and improvement. Drive and support initiatives that address areas of opportunity.
• Collaborate with project team, structuring contract and service agreements to balance risk and reward for both parties. Ensure each relationship is managed appropriate to the scope of the engagement.
• Participate in comprehensive plans for transitioning processes to and from vendors and for managing vendor relationships to ensure maximum, sustainable benefits.
• Meet with vendors on a regular basis to evaluate progress and track results. Ensure contractual obligations are being met by both parties. Ensure pricing and delivery obligations are being met. Verify invoices against contractual pricing and track audit results. Ensure agreed upon metrics are being met or advancing in the right direction.
• Keep internal stakeholders apprised of issues, opportunities and successes. Document results related to key vendors and share status with all stakeholders on a monthly/quarterly basis.
• Support and lead financial audits, accruals, vendor and State settlements, and fee schedule, rate, and reprocessing reconciliation.
• Attract, retain, and develop talent that distinguishes WellSense‘s culture and analytic capabilities.

 

Supervision Exercised:

• May supervise 1 – 3 staff members.

Supervision Received:

• Supervision and support is received weekly and as needed.

 

Qualifications:

Education Required:

• Bachelor’s Degree in Finance, Health Care Administration, or related field required.

Education Preferred:

• Master’s Degree preferred.
• FSA/ASA preferred but not required.

Experience Required:

• Five (5) + years progressively responsible experience in health care financial reporting and analytics required.

Experience Preferred:

• Two (2) + years of prior experience managing a small team of analysts.

Required Licensure, Certification or Conditions of Employment:

• Successful completion of pre-employment background check.

 

Competencies, Skills, and Attributes:

• Expert analyst with an ability to translate findings into real world solutions.
• Ability to use well developed interpersonal skills to direct and influence the efforts of others, both internally and externally.
• Ability to conceptualize and envision the impact of change, and propose new ways to do business.
• Ability to meet deadlines, multi-task, problem solve and use appropriate technology to analyze business problems. Project management skills a plus.
• Strong communications skills, both verbal and written, are required.
• Strong understanding of health care data and analytical methodologies.
• Strong team player.
• Ability to work collaboratively with a variety of business partners.
• Proven process improvement skills.

 

 

Working Conditions and Physical Effort:

• Regular and reliable attendance is an essential function of the position.
• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

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