Manager of Long Term Services and Supports Network Strategy

WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, no matter their circumstances.

Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294387)

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:

Reporting to the Director of Behavioral Health and Long Term Services and Supports (LTSS) Network Strategy, the Manager of LTSS Network Strategy is responsible for contracting the LTSS Network and like services for the applicable WellSense suite of products across multiple states. The Manager of LTSS Network Strategy will be a central point of contact for the LTSS Network. This role, in collaboration with the Director of Behavioral Health and LTSS Network Strategy, will develop and maintain a high performing and competitive LTSS provider network and will create and sustain strong relationships with strategic providers to support achievement of shared WellSense and provider objectives.

The Manager of LTSS Network Strategy will actively engage in division strategy, planning and performance initiatives.

Our Investment in You:

· Full-time remote work

· Competitive salaries

· Excellent benefits

Key Functions/Responsibilities:

· Lead the negotiation and contracting process for a comprehensive LTSS provider network and any applicable like services across WellSense lines of business inclusive of all levels of care and provider/facility types.

· Monitor contract performance and provider metrics to identify opportunities for improvement and ensure compliance with all service level agreement terms with support of Network Operations analytics

· Collaborate cross-functionally in analysis of market trends and to develop strategies for advance market intelligence assessing risks and opportunities to develop effective recruitment approaches across all products

· Support geographical analysis of member access to care gaps in concert with Network Adequacy teams to inform network development efforts

· Mentor, monitor and lead a team of Contract Managers and Providers Relations Representatives providing guidance and support to drive team performance and professional development

· Maintain an up-to-date knowledge of service, financial and regulatory changes for all lines of business and products

· Develop and maintain effective relationships with WellSense Legal, Compliance, Public Partnership, Network Operations, Provider Relations and all other applicable departments to advance the highest quality LTSS network

· Key contributor to the development of value based agreement programs for LTSS providers

· Develop, document and regularly update LTSS training, policy and procedure materials for direct reports

· Other duties and projects as assigned

Supervision Exercised:

• Directly manages 5-10 FTEs

Supervision Received:

· General supervision received from Director, BH and LTSS Network Strategy

Qualifications:

Education Required:

· Bachelor’s degree in related field or High School diploma/equivalent with at least 7-9 years of experience in provider contracting, provider engagement or network management

Education Preferred:

· Master’s degree preferred

Experience Required:

• 5 years network build and / or management experience

• 2 years team supervisory, development and leadership experience

• Effective internal and external presentation skills and presentation development

• Comfortable in a complex matrix environment

• Proficient in influencing teams that do not have a direct reporting relationship

Experience Preferred/Desirable:

· Experience with alternative payment methodologies in the LTSS market

Required Licensure, Certification or Conditions of Employment:

· Successful completion of pre-employment background check

Competencies, Skills, and Attributes:

• Proficient in Power Point, Excel, and Word

• Experience with Microsoft Teams and Sharepoint

Working Conditions and Physical Effort:

• Work is normally performed in a remote home office environment with some travel to providers and office;

• No or very little physical effort required.

• No or very limited exposure to physical risk.

• Regular and reliable attendance is an essential function of the position.

• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.

• May be required to work additional hours beyond standard work schedule.

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. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294387)

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