Director, HPS Regulatory Operations

WelbeHealth•Los Angeles, CA

1d•$159,939 - $211,120

About The Position

At WelbeHealth, we serve our communities’ most vulnerable seniors through shared intention, pioneering spirit, and the courage to love. These core values and our participant-focus lead the way no matter what. The Director, HPS Regulatory Operations is accountable for leading, coordinating, and overseeing all regulatory operations activities within Health Plan Services (HPS) to ensure WelbeHealth remains compliant, audit‑ready, and operationally aligned with federal, state, and contractual requirements. This role translates regulatory requirements into clear, executable operational processes, and provides strong governance, visibility, and accountability across HPS functions. The Director, HPS Regulatory Operations is a member of the HPS leadership team and facilitates collaborative relationships across WelbeHealth and with external regulators and oversight entities. This role is different because the Director, HPS Regulatory Operations at WelbeHealth: Serves as the operational leader for regulatory readiness across HPS, translating complex federal, state, and contractual requirements into scalable processes, controls, and governance structures that support compliance and organizational growth Partners cross-functionally with Compliance, Government Affairs, Operations, Clinical, Network, Finance, and IT leaders to drive audit readiness, mitigate regulatory risk, and ensure consistent execution of regulatory obligations across multiple markets and lines of business

Requirements

Bachelor’s degree in healthcare administration, public health, business administration, regulatory affairs, or a related field required
Minimum of eight (8) years of progressive experience in healthcare regulatory operations, compliance operations, audit management, or health plan administration
Minimum of two (2) years of people leadership experience with demonstrated ability to mentor and develop teams
Must have strong working knowledge of Medicare, Medicaid, and managed care regulatory environments
Demonstrated experience translating regulatory requirements into operational processes and controls
Experience operating in a data‑driven environment and leveraging metrics to manage performance and risk
Excellent written and verbal communication skills, including experience drafting regulatory responses and executive‑level summaries
Must be willing and able to work a varied schedule that may include evenings, nights, weekends, and overtime

Nice To Haves

master’s degree in healthcare administration, public health, or a related field preferred
Formal training or certification in compliance, regulatory affairs, quality, or audit disciplines preferred
multiple state knowledge and experience with Medicare and Medicaid (CA, NJ, and NY) desired

Responsibilities

Serve as the operational owner for regulatory intake, triage, tracking, response coordination, and closure across HPS, as well as establish and maintain a centralized regulatory operations framework including workflows, escalation paths, service‑level expectations, and documentation standards
Oversee all regulatory requests, inquiries, complaints, audits, and examinations impacting HPS (e.g., DHCS, CMS, state Medicaid agencies, delegated oversight entities), as well as own and maintain a regulatory issue log and tracking system to ensure timely responses, trend analysis, and leadership visibility
Lead operational readiness for routine and ad‑hoc audits, surveys, and examinations impacting HPS, as well as partner with HPS functional leaders to ensure audit artifacts, SOPs, and evidence are current, accurate, and readily accessible
Identify root causes from audit findings and regulatory issues, drive corrective action plans and sustained process improvements, and provide executive‑level summaries of audit outcomes, risks, and remediation status
Lead the development and maintenance of SOPs, workflows, and control documentation for HPS regulatory‑impacted processes, as well as standardize documentation, templates, and response formats to improve quality, efficiency, and scalability, ensuring processes are designed to support future growth, delegation, and multi‑state expansion
Proactively identify regulatory and operational risk areas within HPS and recommend mitigation strategies, analyze regulatory trends, complaint drivers, and audit themes to inform leadership decision‑making, and drive continuous improvement initiatives to strengthen controls, reduce variability, and improve response timeliness
Manage direct reports including hiring, training, supervising, and mentoring