Sr. Manager Of Compliance, Health Equity

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:

A Health Equity SME, the Senior Manager ofHealth Equity Compliance will support WellSense in advancing Health Equity for members and will be at the cutting edge of Health Equity innovation and compliance integration through the lens of Health Equity reforms. This position will inform and oversee Health Equity compliance across all WellSense products and assist in integrating Health Equity compliance into business practices, principles, and strategic planning. Additionally, this position supports organization-wide policies, programs, and services aimed at reducing disparities among various population groups and promoting equitable interventions to improve health outcomes.

Using independent judgment and discretion, this position manages all aspects of audit planning, developing compliance audit scope and objectives, performing internal compliance audit procedures and preparing audit reports that reflect the results of the work performed. Additionally, this position is responsible for analyzing the effectiveness of integrating Health Equity compliance for disparities reduction and mitigation of regulatory risk.

Our Investment in You:

• Full-time remote work

• Competitive salaries

• Excellent benefits

Key Functions/Responsibilities:

• Assists in annual Health Equity analysis on prioritized populations and helps lead WellSense Health Plan advocacy efforts externally

• Performs and manages risk assessments and audits to ensure Health Equity compliance with governing bodies, contracts, federal and state regulations and industry standards

• Collaborates with Health Equity leadership to develop member-focused interventions that address systemic barriers to equitable access and cultural competence and helps design inclusive solutions

• Accountable for communicating compliance standards and updates on new, relevant or evolving laws to key stakeholders and business areas (Federal and State regulations, CMS, contractual obligations for new products, etc.)

• Facilitates and plans standing Health Equity workgroup meetings with key stakeholders to share best practices and Health Equity tactics that improve health outcomes

• Represents Health Equity team and serves as an extender to Director of Health Equity Strategy

• Manages effective internal working relationships and trust across stakeholders and senior leaders

• Ensures accurate prioritization of key Health Equity and inclusion projects/programs and informs the incorporation of tailored intervention strategies

• Serves as a WellSense representative and member of Boston Medical Center’s Health Equity Accelerator and partners closely with BMC Population Health team

• Communicates audit findings to leadership in clear and concise format including reports and dashboards

• Follows up on open issues, and facilitates business processes to ensure timely closure and remediation

• Other duties as assigned

Supervision Exercised:

• This is an individual contributor role; it does not have direct reports

Supervision Received:

• General strategic guidance from the Director of Health Equity Strategy.

Qualifications:

Education Required:

• Bachelor’s degree in healthcare administration, public health, or an equivalent combination of education, training and experience.

Education Preferred:

• Master’s degree in healthcare administration or public health

• Educational degrees or credentials emphasizing Health Equity

• Credentials emphasizing diversity, equity, and inclusion

Experience Required:

• 5-7 years of experience in Health Equity, population health, or healthcare compliance

• Experience leading organization-wide policies, programs, or services

• Understanding of general audit standards

• Experience with process improvements and conducting needs/risk assessments

• Experience with diversity, equity, and inclusion in healthcare

Experience Preferred/Desirable:

• Experience conducting studies that identify disparities among various population groups

• Leading advocacy efforts dedicated to promoting Health Equity

• Leading organization-wide policies, programs, or services aimed at achieving Health Equity

• Knowledge and experience with CLAS Standards and/or NCQA Health Equity Accreditation

• 5+ years’ Experience with Medicaid or Medicare managed Health care or health plan

Required Licensure, Certification or Conditions of Employment:

• Successful completion of pre-employment background check.

Competencies, Skills, and Attributes:

• Analytical skills and ability to assess risks
• Ability to be organized and prioritize multiple tasks and assignments in order to meet deadlines
• Strong work ethic, initiative, teamwork, and flexibility to assist department in meeting organizational goals
• Interpersonal skills, including the ability to influence others and establish credibility with stakeholders
• Demonstrated critical thinking skills having identified and solved business problems.
• Excellent interpersonal and communication skills (both verbal and written) required to effectively maintain strong working relationships with internal and external colleagues.
• Ability to deal with ambiguity and change within a fast-paced environment.
• Demonstrated ability to perform in a matrixed environment.
• Able to summarize complex issues/processes simply & effectively and communicate these across teams
• Effective collaborative and proven process improvement skills
• Strong oral and written communication skills; ability to interact within all levels of the organization
• Demonstrated ability to successfully plan, organize and manage audit projects
• Detail oriented
• Demonstrated Learning Agility.
• Basic understanding of Change Management.

Working Conditions and Physical Effort:

• Ability to work East Coast business hours.
• 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.