WellSky

Build and maintain relationships with healthcare providers, educate them on utilization management processes, and analyze engagement data to improve outcomes. | At least 4-6 years of relevant experience, understanding of utilization management principles, and experience in provider education or network engagement. | This a Full Remote job, the offer is available from: Texas (USA) This is a home-based position requiring the candidate to live in the Dallas, TX area. This job is responsible for extensive network building and provider education of assigned market of solutions and clients within the reach of WellSky services. The scope of this job includes working closely with internal teams to highlight the benefits of key referral workflows and programs. The engagement manager plays a critical role in fostering strong relationships with healthcare providers participating in a Utilization Management (UM) program. This role is responsible for educating providers on UM processes, promoting best practices for prior authorization and care coordination, and driving engagement to improve compliance and patient outcomes. We invite you to apply today and join us in shaping the future of healthcare! Key Responsibilities: • Cultivate strong, consultative relationships with assigned risk-bearing provider networks to drive engagement and meet client needs. • Educate and support providers in navigating UM processes, including prior authorizations, medical necessity reviews, and evidence-based care guidelines. • Serve as a key liaison between providers and the UM team, ensuring clear communication, issue resolution, and ongoing support. • Act as the in-market expert by managing implementation, education, and continuous engagement for referral benefits and workflows. • Collaborate with internal teams to execute engagement plans, deliver provider education, and analyze data to identify opportunities for intervention and improvement. • Serve as an in-market expert, build relationships with key stakeholders, and promote WellSky solutions at clinical summits, town halls, and provider meetings. • Provide regular updates on provider engagement performance, program feedback, and market insights to internal teams and clients. • Partner with marketing and operational teams to create educational and promotional materials supporting provider engagement efforts. • Monitor provider performance and engagement trends, analyzing UM-related data to identify opportunities for intervention, workflow optimization, and improved patient outcomes. • Perform other job duties as assigned. Required Qualifications: • At least 4-6 years relevant work experience. • Bachelor's Degree or equivalent work experience. Preferred Qualifications: • Proven ability to engage, educate, and influence healthcare providers in a healthcare or relevant domain preferably in a UM or care management setting. • Strong understanding of Utilization Management principles, payer-provider dynamics, and prior authorization workflows. • Experience in provider education, network engagement, or compliance monitoring. • Ability to analyze data to drive strategic engagement. • Experience articulating scorecards, performance metrics, and provider outreach strategies. • Experience in coaching and development of clinical programs to increase provider quality metrics. Job Expectations: • Willing to travel up to 30% based on business needs. • Willing to work additional or irregular hours as needed. • Must work in accordance with applicable security policies and procedures to safeguard company and client information. • Must be able to sit and view a computer screen for extended periods of time. #LI-PG1 #LI-Remote WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference. WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace. Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates. Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky: • Excellent medical with Rx, dental, and vision benefits • Mental Health support through EAP • Generous paid time off, plus 13 paid holidays • 100% vested 401(K) retirement plans • Educational assistance up to $2500 per year This offer from "WellSky" has been enriched by Jobgether.com and got a 72% flex score.

Build and maintain relationships with healthcare providers, educate them on utilization management processes, and analyze data to improve engagement and patient outcomes. | At least 4-6 years of relevant experience, understanding of UM principles, provider education, and data analysis skills. | This is a home-based position requiring the candidate to live in the Dallas, TX area. This job is responsible for extensive network building and provider education of assigned market of solutions and clients within the reach of WellSky services. The scope of this job includes working closely with internal teams to highlight the benefits of key referral workflows and programs. The engagement manager plays a critical role in fostering strong relationships with healthcare providers participating in a Utilization Management (UM) program. This role is responsible for educating providers on UM processes, promoting best practices for prior authorization and care coordination, and driving engagement to improve compliance and patient outcomes. We invite you to apply today and join us in shaping the future of healthcare! Key Responsibilities: • Cultivate strong, consultative relationships with assigned risk-bearing provider networks to drive engagement and meet client needs. • Educate and support providers in navigating UM processes, including prior authorizations, medical necessity reviews, and evidence-based care guidelines. • Serve as a key liaison between providers and the UM team, ensuring clear communication, issue resolution, and ongoing support. • Act as the in-market expert by managing implementation, education, and continuous engagement for referral benefits and workflows. • Collaborate with internal teams to execute engagement plans, deliver provider education, and analyze data to identify opportunities for intervention and improvement. • Serve as an in-market expert, build relationships with key stakeholders, and promote WellSky solutions at clinical summits, town halls, and provider meetings. • Provide regular updates on provider engagement performance, program feedback, and market insights to internal teams and clients. • Partner with marketing and operational teams to create educational and promotional materials supporting provider engagement efforts. • Monitor provider performance and engagement trends, analyzing UM-related data to identify opportunities for intervention, workflow optimization, and improved patient outcomes. • Perform other job duties as assigned. Required Qualifications: • At least 4-6 years relevant work experience. • Bachelor's Degree or equivalent work experience. Preferred Qualifications: • Proven ability to engage, educate, and influence healthcare providers in a healthcare or relevant domain preferably in a UM or care management setting. • Strong understanding of Utilization Management principles, payer-provider dynamics, and prior authorization workflows. • Experience in provider education, network engagement, or compliance monitoring. • Ability to analyze data to drive strategic engagement. • Experience articulating scorecards, performance metrics, and provider outreach strategies. • Experience in coaching and development of clinical programs to increase provider quality metrics. Job Expectations: • Willing to travel up to 30% based on business needs. • Willing to work additional or irregular hours as needed. • Must work in accordance with applicable security policies and procedures to safeguard company and client information. • Must be able to sit and view a computer screen for extended periods of time. #LI-PG1 #LI-Remote WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference. WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace. Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates. Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky: • Excellent medical with Rx, dental, and vision benefits • Mental Health support through EAP • Generous paid time off, plus 13 paid holidays • 100% vested 401(K) retirement plans • Educational assistance up to $2500 per year

Manage project schedules, lead meetings, assign tasks, identify risks, and maintain communication between clients and internal teams to ensure successful software implementations. | Bachelor’s degree or equivalent experience, 4-6 years relevant project management experience, willingness to travel up to 25%, and ability to work irregular hours as needed. | The Implementation Project Manager is responsible for overall project management and support of client software implementation projects. The scope of this job includes managing overall project schedule by partnering with resource owners and executive sponsors to ensure activities are carried out in accordance with established goals and budgets. We invite you to apply today and join us in shaping the future of healthcare! Key Responsibilities Create and oversee project schedules based on scope and resources, manage daily operations, and make revisions as needed to keep projects on track and within budget. Assign tasks, provide project updates and reports, identify potential risks, and lead project planning and status meetings. Develop an understanding of each client’s business and objectives to enhance project execution and identify future sales opportunities. Facilitate both project management and executive steering committee meetings to ensure alignment between client and WellSky teams. Create relationships with the client project manager and project sponsor to facilitate effective and timely communication. Leverage existing methods and procedures to facilitate consistent and repeatable results across the project team. Perform other job duties as assigned. Required qualifications Bachelor’s degree or equivalent work experience At least 4-6 years of relevant work experience Job Expectations Willing to travel up to 25% based on business needs Willing to work additional or irregular hours as needed Must work in accordance with applicable security policies and procedures to safeguard company and client information Must be able to sit and view a computer screen for extended periods of time #LI-OF1 #LI-Remote WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference. WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace. Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates. Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky: Excellent medical, dental, and vision benefits Mental health benefits through TelaDoc Prescription drug coverage Generous paid time off, plus 13 paid holidays Paid parental leave 100% vested 401(K) retirement plans Educational assistance up to $2500 per year WellSky is a technology company leading the movement for intelligent, coordinated care worldwide. Our next-level software, analytics, and services power better outcomes and lower costs for stakeholders across the health and community care continuum. In today’s value-based care environment, WellSky helps providers, payers, health systems, and community organizations solve tough challenges, improve collaboration for growth, harness the power of data analytics, and achieve better outcomes by further connecting clinical and social care.

Ensure compliance with CMS and NCQA standards through performance measurement, audits, data analysis, and quality improvement initiatives in healthcare settings. | 4-6 years healthcare quality management experience, preferably clinical background (RN, OT, PT), proficiency with CMS/NCQA audits, strong communication and data skills. | Description: • Facilitate activities related to performance measurement and outcomes, ensure the organization meets CMS, NCQA, and other regulatory standards, stay updated on relevant regulatory changes, and support their integration into practices. • Comply with state, federal, and organizational standards by assisting in the development and enforcement of policies aligned with Utilization Management and Quality Improvement Program requirements. • Guide the implementation of internal audit protocols in compliance with CMS regulations and NCQA standards, and contribute to the consistency of clinical documentation and decision-making processes. • Analyze data to identify trends and areas for improvement, and execute defined projects aimed at enhancing care quality across various lines of business. • Generate and validate reports to monitor performance and compliance across health plan contracts, ensuring accuracy and alignment with requirements. • Prepare for regulatory, accreditation, and contractual audits, and contribute to the remediation and documentation of audit findings. • Perform other job duties as assigned Requirements: • Bachelor's Degree or equivalent work experience • At least 4-6 years of relevant experience in healthcare quality management and post-acute care utilization management • Preferred: Registered Nurse, Occupational Therapist, or Physical Therapist with a bachelor’s degree in a related field, or a combination of education and experience that includes pertinent clinical experience and an understanding of CMS standards and guidelines • Experience with CMS and/or NCQA audits • Ability to manage multiple competing priorities and tasks effectively • Strong written, oral, and interpersonal communication skills • Demonstrated ability to collaborate with external vendors and clients • Proficiency in manipulating and sorting data for analytics and reporting • Excellent analytical and data interpretation skills • Experience in case management in a healthcare setting • Applicants for U.S.-based positions must be legally authorized to work in the United States • Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates Benefits: • Excellent medical, dental, and vision benefits • Mental health benefits through TelaDoc • Prescription drug coverage • Generous paid time off, plus 13 paid holidays • Paid parental leave • 100% vested 401(K) retirement plans • Educational assistance up to $2500 per year

Manage compliance with healthcare quality and utilization management programs by analyzing data, ensuring regulatory adherence, and supporting audits across post-acute care settings. | Requires 4-6 years healthcare quality management experience, preferably clinical licensure (RN, OT, PT), knowledge of CMS and NCQA standards, and strong data and communication skills. | The Clinical Quality Program Manager is responsible for ensuring compliance with WellSky's Utilization Management and Quality Improvement Program by serving as a clinical expert on state and federal regulations. The scope of this job includes analyzing and presenting data to establish best practices across post-acute health care settings, including LTACHs, IRFs, SNFs, and Home Health facilities. We invite you to apply today and join us in shaping the future of healthcare! Key Responsibilities: Facilitate activities related to performance measurement and outcomes, ensure the organization meets CMS, NCQA, and other regulatory standards, stay updated on relevant regulatory changes, and support their integration into practices. Comply with state, federal, and organizational standards by assisting in the development and enforcement of policies aligned with Utilization Management and Quality Improvement Program requirements. Guide the implementation of internal audit protocols in compliance with CMS regulations and NCQA standards, and contribute to the consistency of clinical documentation and decision-making processes. Analyze data to identify trends and areas for improvement, and execute defined projects aimed at enhancing care quality across various lines of business. Generate and validate reports to monitor performance and compliance across health plan contracts, ensuring accuracy and alignment with requirements. Prepare for regulatory, accreditation, and contractual audits, and contribute to the remediation and documentation of audit findings. Perform other job duties as assigned Required Qualifications: Bachelor's Degree or equivalent work experience. At least 4-6 years of relevant experience in healthcare quality management and post-acute care utilization management. Preferred Qualifications: Registered Nurse, Occupational Therapist, or Physical Therapist with a bachelor’s degree in a related field, or a combination of education and experience that includes pertinent clinical experience and an understanding of CMS standards and guidelines. Experience with CMS and/or NCQA audits. Ability to manage multiple competing priorities and tasks effectively. Strong written, oral, and interpersonal communication skills. Demonstrated ability to collaborate with external vendors and clients. Proficiency in manipulating and sorting data for analytics and reporting. Excellent analytical and data interpretation skills. Experience in case management in a healthcare setting. Job Expectations: Willing to work additional or irregular hours as needed Must work in accordance with applicable security policies and procedures to safeguard company and client information Must be able to sit and view a computer screen for extended periods of time #LI-OF1 #LI-Remote WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference. WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace. Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates. Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky: Excellent medical, dental, and vision benefits Mental health benefits through TelaDoc Prescription drug coverage Generous paid time off, plus 13 paid holidays Paid parental leave 100% vested 401(K) retirement plans Educational assistance up to $2500 per year WellSky is a technology company leading the movement for intelligent, coordinated care worldwide. Our next-level software, analytics, and services power better outcomes and lower costs for stakeholders across the health and community care continuum. In today’s value-based care environment, WellSky helps providers, payers, health systems, and community organizations solve tough challenges, improve collaboration for growth, harness the power of data analytics, and achieve better outcomes by further connecting clinical and social care.

Oversee and manage a team of clinical operations staff ensuring efficient and accurate completion of tasks related to utilization review and care coordination. | Bachelor's degree, 4-6 years clinical nursing or therapy experience, active RN license, knowledge of utilization management tools, and ability to manage clinical teams. | The Sr. Team Lead, Clinical Operations is responsible for overseeing the team responsible for coordinating and delivering care to patients as part of payer programs authorized by their health insurance provider. The scope of this job includes providing operational and management oversight a team of clinicians and other members of the clinical team but does not include providing clinical oversight to staff. This position oversees a team of Utilization Review Clinicians who are responsible for timely review of request for post-acute services based on established clinical guidelines and/or coverage benefits limitations to determine appropriateness of requested services. Alongside their team, the Sr. Team Lead, Clinical Operations will develop relationships with physicians, healthcare service providers, and internal and external clients to help improve health outcomes for enrollees. They will apply clinical knowledge to work with facilities and providers for care coordination and comply with all standard operating procedures, as well as departmental and organizational policies. They will access and consult with peer clinical reviewers, Medical Directors, and/or delegated clinical reviewers to help ensure medically appropriate, quality, and cost-effective care throughout the medical management process. The ideal candidate will possess a passion for coaching and mentoring others, as well as working knowledge and aptitude of the Microsoft suite of applications (e.g., Office, Excel), clinical decision support tools and operational software. We invite you to apply today and join us in shaping the future of healthcare! Key Responsibilities: Oversee daily operations of clinical operation support staff and ensure tasks are completed efficiently and accurately. Identify and address operational challenges and escalate more complex issues to management as needed. Support the development and implementation of work plans, assign tasks, and ensure alignment with program objectives. Manage larger, more-complex and growing or expanded clinical programs. Provide enhanced training and mentorship to team members by fostering skill development and professional growth. Collaborate with managers on recruitment, onboarding, and performance feedback for team members. Analyze team performance data and recommend process improvements to enhance quality, efficiency, and service outcomes. Perform other job duties as assigned. Required Qualifications: Bachelor's Degree or equivalent work experience 4-6 years of clinical nursing or therapy experience Active RN license Preferred Qualifications: 1-2 years' experience in utilization review, case management and/or managed care regulations Experience with MCG (Milliman Care Guidelines), InterQual or other clinical decision support tools, especially in utilization management and prior authorization processes General understanding of managed care guidelines and impact on services Job Expectations: Able to pass federal and state required background checks and drug screen Willing to travel up to 30% based on business needs. Willing to work additional or irregular hours as needed. Must work in accordance with applicable security policies and procedures to safeguard company and client information. Must be able to sit and view a computer screen for extended periods of time. WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference. WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace. Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates. Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky: Excellent medical, dental, and vision benefits Mental health benefits through TelaDoc Prescription drug coverage Generous paid time off, plus 13 paid holidays Paid parental leave 100% vested 401(K) retirement plans Educational assistance up to $2500 per year WellSky is a technology company leading the movement for intelligent, coordinated care worldwide. Our next-level software, analytics, and services power better outcomes and lower costs for stakeholders across the health and community care continuum. In today’s value-based care environment, WellSky helps providers, payers, health systems, and community organizations solve tough challenges, improve collaboration for growth, harness the power of data analytics, and achieve better outcomes by further connecting clinical and social care.