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.

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 Vice President of Network Strategy, the Director of Behavioral Health Network Strategy is responsible for contract strategy and execution for WellSense Health Plan’s behavioral health (BH) network for Medicare, Medicaid and Commercial products across multiple states. The Director of BH Network Strategy will be a thought leader and central point of contact for the BH network within the organization. The Director will enable a high performing BH provider network and will foster and maintain strong relationships with strategic providers to support achievement of shared plan and provider objectives.

The Director of BH Network Strategy is member of the provider network leadership team and will be actively engaged in division strategy, planning and performance initiatives.

Our Investment in You:

Key Functions/Responsibilities:

Lead strategy for advance market intelligence to ensure a best-in-class BH network
Assesses all product BH provider network needs for each market (services, provider/facility types, network adequacy)
Supports geographical analysis of member access to care gaps
Ensures operational, strategic, and tactical alignment across the negotiation teams
Develops new and enhances existing relationships with BH providers across multiple states
Create VBP programs for multiple provider types
Development of network BH training and reporting materials
Other duties and projects as assigned.
Coordinates contracting-related activities, including contract evaluation, rate impact modeling, contract language review, negotiations, delegation of credentialing, contract implementation and contract compliance.This includes non-par single case rate oversight and transplant network strategy.
Communicates throughout the organization on issues related to contracts, payer policies and procedures, payer benefit programs, etc.
Maintains up-to-date competitive information, including: competitors' network composition, network reimbursement, provider incentive arrangements, medical and utilization management practices, technology and electronic communication methods used by competitors in support of their network providers.
Partners with state contracting directors and engages providers in ACO and other alternative payment contracts. Ensures staff is trained to support providers in these relationships leverage plan resources such as reporting and care management expertise.

Supervision Exercised:

Supervises team of Contract Managers

Supervision Received:

General supervision received weekly

Qualifications:

Education Required:

Bachelor’s degree in related field

Education Preferred:

Experience Required:

5 years of BH network build and or management experience
Experience implementing strategic initiatives in contracting and network management
8 to 10 years of increasingly responsible health care management experience that demonstrates leadership ability in creating and implementing strategic initiatives in hospital administration, contracting, and network management.
Extensive experience in Medicare and Medicaid environment
Network management leadership experience is strongly preferred.
Experience in a Medicaid managed care environment is strongly preferred.
Experience negotiating complex, large financial volume agreements with hospitals, physicians and ancillary services, and developing and administering provider incentive and pay-for-performance programs preferred.

Required Licensure, Certification or Conditions of Employment:

Successful completion of pre-employment background check

Competencies, Skills, and Attributes:

Exceptional relationship building and communication skills. Ability to effectively communicate the organization’s vision and benefit of provider participation.
Ability to build and maintains mutually beneficial relationships with providers. Intentionally and consistently provides high quality service and successfully delivers on commitments.
Seeks solutions, demonstrates ability to get the job done; overcomes obstacles.
Demonstrated ability to lead teams in the achievement of departmental and organizational goals is required. Proficient in influencing teams that do not have a direct reporting relationship
Ability to think tactically and strategically.
Successful candidate will have the ability to analyze complex contracts and financials.
Must possess a strong orientation toward superior provider and customer satisfaction and effective interpersonal and conflict resolution skills.
Must be collaborative, flexible and comfortable operating and influencing in a matrix environment
Exceptional organization skills required
Must be able to present to all levels within the organization
Proficient in Microsoft software products such as Teams, Power Point, Excel, and Word

Working Conditions and Physical Effort:

Must be able to work under normal office conditions in a remote home office environment.
May be required to work additional hours beyond standard work schedule.
Occasional travel within New England region to meet with network teams, providers or regulators required
May be required to travel to attend company on-site meetings.

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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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.

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