Job Opportunities API

TURNING EVERYDAY CHECK-INS INTO BETTER OUTCOMES FOR THE MEMBERS WHO NEED IT MOST. Wellth is a healthcare technology company that uses behavioral science and real-time engagement to help health plans improve medication adherence, close care gaps, and drive better outcomes for their highest-need members. Our platform combines a daily check-in app with a cue-routine-reward highlight engine and a human-in-the-loop Member Care Advocate (MCA) layer — creating a dual-channel system that reaches members where they are and escalates intelligently when they need more. Our platform combines a daily check-in app with a cue-routine-reward highlight engine and a human-in-the-loop Member Care Advocate (MCA) layer — creating a dual-channel system that reaches members where they are and escalates intelligently when they need more. As Wellth expands its quality improvement programs into HEDIS, Medicare Stars, and chronic condition management, the MCA function is evolving from a reactive support role into a proactive, data-driven care navigation capability. The MCA Manager will build and lead this next chapter. BUILD THE ENGINE THAT TURNS MEMBER DATA INTO BETTER CARE -- WHILE KEEPING YOUR HANDS ON THE WHEEL. The Member Care Advocate Manager oversees the MCA team's day-to-day operations while building the analytical and programmatic infrastructure that turns raw member engagement data into targeted, timely care interventions. This is a player-coach role for our current stage: you will carry a small personal portfolio of complex member cases while simultaneously designing the systems, workflows, and team capabilities that will scale across a growing membership base. You will sit at the intersection of quality strategy, product operations, and front-line care — translating HEDIS measure logic, PDC-clock math, and Stars priority scoring into clear daily queues and coaching for your advocates. You will own the four-phase operational cycle — Data Aggregation, Risk Stratification, Trend Detection & Gap Analysis, and Intervention — and be accountable for the team's contribution to measure closure rates. Your work will be split into 4 main responsibilities: Data Aggregation & Member Intelligence - Synthesize member data from the Wellth app highlight engine, Member Care Queues, supplemental data feeds (pharmacy, lab, claims), and partner health plan sources into a unified, advocate-ready view. - Define and maintain the data standards and intake processes that ensure every member's current measure status, PDC calculation, and outreach history are current before advocates make contact. - Partner with Product and Engineering to surface actionable signals through the Member Care Queue interface rather than requiring advocates to manually navigate raw data. - Operate and refine Wellth's cohort segmentation model, assigning members to tiers ranging from digitally self-sufficient to advocate-forward based on engagement history, measure gaps, and clinical risk. Risk Stratification & Cohort Management - Translate PDC-clock mathematics and HEDIS measure timelines into calendar-driven prioritization — ensuring advocates always work the highest-impact members first within each measurement year window. - Own the priority scoring formula and escalation thresholds; adjust parameters in response to real-world close rates and changing plan priorities. - Identify and flag members in advocate-forward measures (particularly FUM/FUH follow-up after behavioral health discharge and TRC transitions of care) where the MCA call is the entry point — not the fallback. Trend Detection & Gap Analysis - Monitor aggregate performance across priority HEDIS measures detect cohort-level or geography-level anomalies before they become measure-year liabilities. - Flag emerging clinical trends: low preventive screening rates in specific markets, rising rates of uncontrolled diabetes or medication adherence - Collaborate with the Quality team to