Note: The job is a remote job and is open to candidates in USA. WelbeHealth is seeking a Director, Quality Operations to lead and continuously improve its PACE quality program, supporting participant safety, regulatory readiness, and care outcomes. The role oversees quality operations teams, uses data to drive performance improvements, and communicates quality results to team members, board committees, and regulatory agencies.
Responsibilities
- Collaborate with the VP, Quality Operations to develop and standardize enterprise metrics in clinical excellence, quality, and patient safety in alignment with all policies and procedures, as well as local, state, federal, and CDC guidelines
- Collaborate with the VP, Quality Operations and other Directors, Quality Operations to develop standardized quality operations workflows, playbooks, tools, and other quality operations resources, as well as to implement standardized and scalable approaches to collecting data, analyzing data, and generating data visualizations and reports
- Partner with Analytics and Performance Excellence Teams to analyze and review operational performance for continuous process improvements, increased efficiency, and participant satisfaction
- Monitor and analyze data including quality improvement (QI) plan metrics, HPMS entries, company and market initiatives, and corrective action plans (CAPs) to identify trends and areas for process improvement
- Act as a QI subject matter expert on program and company initiatives as needed, such as collaborating with the Compliance team on initiatives to monitor and improve compliance issues, CAPs, and the Fraud, Waste, and Abuse program
- Collaborate with the Quality Operations team and Compliance Officer to ensure PACE program complaints are appropriately investigated, responded to, and documented, as well as support PACE program procedures to process grievances and complaints in accordance with applicable state and federal regulations, policies and procedures, and compliance standards
- Ensure complete and timely submission of all information required by regulatory agencies including but not limited to HPMS quality reporting, CMS Quarterly calls, enrollment denials, and audit requirements
Skills
- Bachelor's degree in relevant field; professional experience may be substituted
- Five (5) years of experience required, three (3) years of which must be as a QI/assurance Director/Manager in a healthcare setting, or in managing health/elder care programs with oversight of QI or compliance
- Three (3) years of supervisory experience with demonstrated ability to mentor and develop team members
- Hands-on experience working with the California DHCS and navigating state-level regulatory expectations
- Experience with regulatory compliance and audits required, including preparing for and responding to CMS, DHCS, and other state/federal regulatory reviews
- Demonstrated experience developing, implementing, and managing QI plans in alignment with regulatory requirements
- Experience and exceptional capabilities managing data and conducting analyses using productivity suite software including complex spreadsheets and data visualization tools
- Experience developing, managing, and monitoring CAPs to address compliance and quality issues; proven ability to lead process improvement initiatives, identify gaps, and implement sustainable operational enhancements
- Master's degree in relevant field preferred
- Experience as Lean Six Sigma green belt or black belt preferred
- Formal QI and analytics certifications preferred
- Experience working with and implementing PACE regulations preferred
- Excel and PowerBI experience a plus
Benefits
- Medical insurance coverage (Medical, Dental, Vision)
- 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days
- 401K savings + match
- Bonus
- Remote work, with the ability to travel onsite as needed for business and regulatory requirements
Company Overview
Company H1B Sponsorship