Health Equity Compliance and Operations Manager 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/294479) 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 Health Equity Compliance and Operations Manager plays a critical role in advancing the organization’s commitment to improving health outcomes for all populations, with a particular focus on underserved and vulnerable communities. This individual will oversee the qualitative and quantitative analysis of aggregated data, and management of health equity reporting to regulators such as NCQA, EOHHS, DHHS, CMS and others.** **The role requires a blend of regulator expertise, qualitative and quantitative analysis skills, health plan experience, and a deep understanding of social determinants of health, to ensure that WellSense is positioned to meet regulator requirements as well as inform policies and programs aimed at reducing health inequities. The Compliance and Operations Manager will collaborate with cross-functional teams, to support the development of strategies that promote health equity across all populations as well as develop required reporting and analysis to maximize Health Equity Incentive and ensure NCQA standards are met.** **Key responsibilities include collaboration with the data analytics teams on statistical analyses, creating reports, and presenting findings in accessible ways, and reporting submissions to regulators as requested. The manager will also assist in the development of data-driven tools such as a health equity dashboard, population health needs assessment, and frameworks to track health equity metrics and outcomes, while actively supporting a culture of continuous improvement and data transparency.** **This position requires a strong foundation in NCQA, health policy, and social determinants of health, as well as a passion for advancing equity and justice in healthcare.** Our Investment in You: · Full-time remote work · Competitive salaries · Excellent benefits **Key Functions/Responsibilities:** · Work with the data and analytics team members to analyze appropriate Health Equity DEIA data, including but not limited to RELDSOGI, HRSN, Disability, and others; to create reporting that will be reviewed by leadership for submission to regulators such as NCQA, MA EOHHS and NH DHHS. · Oversee Health Equity reporting to regulators, including, NCQA, MA EOHHS, NH DHHS, CMS, and others, ensuring all reports are submitted timely, accurately, and appropriately. · Analyze patient demographics, screening outcomes, and health outcomes using clinical, claims, and other health plan data to meet reporting requirements for NCQA Accreditation, QEIP, and other regulatory needs. · Develop qualitative and quantitative analysis of Health Equity data, including RELDSOGI, HRSN, and Disability, to create reports for leadership review and submission to regulators such as NCQA, MA EOHHS, NH DHHS, CMS, and others. · Develop and oversee performance monitoring tools, such as monthly performance dashboards, to help stakeholders monitor performance, observe trends, and identify opportunities for improvement as well as new health equity initiatives. · Assist in conducting annual health equity population health needs assessment and analysis to identify disparities and opportunities for intervention. · Work with the Health Equity DEIA team and Data Analytics team to define and execute data reporting needs and evaluations of Health Equity programming. · Develop data analysis reports and dashboards that are easily understandable by clinical, strategy, NCQA accreditation and quality teams. **Supervision Exercised:** **·** **This role does not have supervision responsibilities.** **Supervision Received:** **·** **Direct supervision from a Manager is received weekly.** **Qualifications:** **Education Required:** · Bachelor’s degree in public health, Health Policy, or a related field; Master’s degree preferred. **Education Preferred:** + Bachelor’s or master’s degreeHealth Policy, Public Health, Human Services, or a related field; Master’s degree preferred. + Educational degrees or credentials emphasizing health equity + **Familiarity with federal and state health equity regulations, policies, and initiatives.** **Experience Required:** · At least 3-5 years of experience in health plans, with a focus on health equity, public health, or social determinants of health. · Experience working with diverse populations, particularly underserved or marginalized communities, and a demonstrated commitment to advancing health equity. **Required Licensure, Certification or Conditions of Employment:** · Successful completion of pre-employment background check. **Competencies, Skills, and Attributes:** · Proficiency in NCQA requirements EOHHS Quality and Equity Incentive Program and other regulatory bodies. · In-depth understanding of health disparities, social determinants of health, and the policies and systems that impact health equity. · Strong knowledge of public health data standards, reporting protocols, and health equity frameworks. · Understanding of qualitative and quantitative research methods, with the ability to design and implement evaluations and assessments related to health equity. · Excellent written and verbal communication skills, with the ability to translate complex data into clear, actionable insights for both technical and non-technical audiences. · Ability to create compelling reports, presentations, and visualizations to support health equity initiatives and decision-making. · Strong collaboration skills with a proven ability to work across interdisciplinary teams and engage with stakeholders from various sectors, including government agencies, community organizations, and healthcare providers. **·** **Ability to manage multiple projects simultaneously and prioritize tasks effectively in a fast-paced environment.** **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. 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/294479) **Important info on employment offer scams:** According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not solicit individuals via text, we do not ask or require downloads of any applications, or “apps,” and applicant screenings, interviews and job offers are not conducted over text messages or social media platforms. You should never pay money for the promise of priority, interview or employment. We do not ask individuals to purchase equipment for, or prior to employment. To avoid becoming a victim of an employment offer scam, please followthese tips from the FTC (https://consumer.ftc.gov/consumer-alerts/2023/01/looking-job-scammers-might-be-looking-you?utm\_source=govdelivery) _._