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Salary: USD 159,939 - 211,120 / annual
WelbeHealth is seeking a Director, Quality Operations to develop and implement an effective and robust PACE quality program ensuring participant safety and care excellence. Reporting to the Vice President of Quality Operations, this role leads enterprise-wide quality strategy and compliance excellence, driving the design, implementation, and continuous improvement of the PACE quality program while directly impacting participant safety, regulatory readiness, and care outcomes.
Key responsibilities include:
- Collaborating with the VP, Quality Operations to develop and standardize enterprise metrics in clinical excellence, quality, and patient safety aligned with all policies, procedures, and local, state, federal, and CDC guidelines
- Developing standardized quality operations workflows, playbooks, tools, and resources with other Directors to implement scalable approaches to data collection, analysis, and visualization
- Partnering with Analytics and Performance Excellence Teams to analyze operational performance for continuous process improvements, efficiency gains, and participant satisfaction
- Monitoring and analyzing quality improvement plan metrics, HPMS entries, company initiatives, and corrective action plans to identify trends and improvement opportunities
- Acting as a QI subject matter expert on program and company initiatives, including collaboration with Compliance on compliance monitoring, CAPs, and Fraud, Waste, and Abuse programs
- Ensuring PACE program complaints are appropriately investigated, responded to, and documented in accordance with applicable regulations
- Ensuring timely submission of all regulatory agency requirements including HPMS quality reporting, CMS Quarterly calls, enrollment denials, and audit requirements
This role is unique because it combines enterprise-wide quality strategy leadership with cross-functional partnership to translate complex data into actionable insights that strengthen performance and elevate quality across the organization.
REQUIREMENTS:
- Bachelor's degree in relevant field (professional experience may be substituted; master's degree preferred)
- Five (5) years of experience required, with three (3) years minimum as a QI/assurance Director/Manager in a healthcare setting or managing health/elder care programs with QI or compliance oversight
- Three (3) years of supervisory experience with demonstrated ability to mentor and develop team members
- Hands-on experience working with California DHCS and navigating state-level regulatory expectations; PACE regulations experience preferred
- 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 aligned with regulatory requirements
- Exceptional capabilities managing data and conducting analyses using productivity suite software including complex spreadsheets and data visualization tools; Excel and PowerBI experience a plus
- Experience developing, managing, and monitoring CAPs to address compliance and quality issues; proven ability to lead process improvement initiatives and implement sustainable operational enhancements
- Lean Six Sigma green belt or black belt preferred; formal QI and analytics certifications preferred
- Candidates must reside in California, preferably in Northern California or within a 2-hour direct flight of Sacramento, with ability to travel onsite as needed for business and regulatory requirements
