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.

Responsible for the daily supervision and operations of the Acute Care Coordination (ACC) specialist team. Trains staff, assigns work, ensures compliance with policies and procedures and is the first point of contact for complex issues to ensure cost effective utilization management of inpatient admissions. Implements and performs quality assurance audits. Monitors productivity and efficiency reporting and adjusts workflows/staffing as needed. Works closely with the Manager of Inpatient UM and the Inpatient UM Clinical Supervisor.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Monitors and evaluates the quality, timeliness and accuracy of ACC Specialist work
• Collaborates with prior authorization team and care management team.
• Participates in staff hiring, work allocation, training, performance management in collaboration with the Manager of Inpatient Utilization Management, professional development and related supervisory functions.
• Assists with and participates in the planning, development and implementation of department specific and cross functional projects.
• Under the direction of the Manager of Inpatient Utilization Management develops and uses metrics and management reports to monitor staff productivity and efficiency.
• Responsible for maintaining accurate, consistent, updated departmental policies, procedures and work flows and related training materials.
• Participates in special project work as requested by the Manager of Inpatient Utilization Management
• Conducts routine audits to monitor compliance with workflows and policies.
• Other functions as required to support departmental activities.

Supervision Exercised:

• Directly supervises 5-15 staff.

Supervision Received:

• General supervision is received weekly.

Qualifications:

Education:

• Associates degree in healthcare, nursing or a related area, or equivalent relevant work experience is required.

Preferred/Desirable:

• Experience with inpatient utilization management strongly preferred
• Experience with CCMS preferred

Experience:

• 1 year of prior supervisory experience preferred
• 2 or more years in a managed care organization is required.
• Experience with Medicaid recipients

Certification or Conditions of Employment:

• Pre-employment background check

Competencies, Skills, and Attributes:

• Ability to lead a team
• Strong written communication skills; ability to interact with all levels of the organization as well as external contacts
• Strong organizational and time management skill
• Able to work in a fast pace environment and multi-task
• Experience with standard Microsoft Office applications
• Strong analytical and problem solving 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.
• Travel to regional offices required.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 440,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

• WellSense will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.