Director, Quality Operations

WelbeHealth•Los Angeles, CA

16h•Hybrid

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. Under the direct supervision of the Vice President, Quality Operations, the Director, Quality Operations develops and implements an effective and robust PACE quality program that ensures WelbeHealth participants are uniquely cared for. As a compliance leader and driver of care excellence, the Director, Quality Operations oversees Quality Operations activities, leads Quality Operations teams, and effectively communicates quality results to team members, the board and its committees, and regulatory agencies. The Director, Quality Operations continuously identifies education and training opportunities to improve team member performance. This role is different because the Director, Quality Operations at WelbeHealth: Leads enterprise-wide quality strategy and compliance excellence - driving the design, implementation, and continuous improvement of the PACE quality program, directly impacting participant safety, regulatory readiness, and care outcomes. Partners cross-functionally to turn data into action – collaborating with Analytics, Compliance, and Operations teams to translate complex data into actionable insights, strengthen performance, and elevate quality across the organization.

Requirements

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; 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, identify gaps, and implement sustainable operational enhancements

Nice To Haves

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

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