Member Care Advocate Manager

USE YOUR DATA EXPERIENCE TO HELP PEOPLE LIVE HEALTHIER Have you ever wanted to apply your data leadership skills and experience to help others live healthier lives? At Wellth, we have an opportunity for you to do that. Wellth strives to motivate and incentivize healthy habits through individualized care plans. Our approach draws on a unique combination of behavioral economics, habit science, and cutting-edge technology to drive positive behavior and habit change among some of the US's most underserved and high-needs patient populations. Our work has produced demonstrable results, with several large health insurers reporting significant reductions in hospitalization rates by up to 44%. Our ambition is to be a category leader in the $88B health outcomes market, singularly focused on improving the lives and medical outcomes of historically hard-to-engage populations. Our work immediately impacts people's lives daily; we have served over 100,000 members and prevented an estimated tens of thousands of days in the hospital, literally saving lives. Data is the beating heart of Wellth’s products, powering our outreach, mobile app experiences, internal analytics, and customer-facing reporting that drives our customer expansions. Your active ownership of the data vision and team will lead the company to continued growth in our mission to help members live healthier and happier lives. ABOUT THE ROLE 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. WHAT YOU'LL DO Phase 1 — 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. Phase 2 — Risk Stratification & Cohort Management - 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. - 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. Phase 3 — 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 pr…