Regional Quality Operations Specialist

WelbeHealth•Stockton, CA

3d•$74,613 - $98,489•Remote

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 supervision of the Quality Operations Director (QOD), and in close collaboration with the VP of Quality Operations, Executive Directors (EDs), and Medical Directors, the Regional Quality Operations Specialist is accountable for the implementation and maintenance of the WelbeHealth Quality Operations program. This role assists with audits, as well as monitors staff compliance with state and federal regulations and WelbeHealth policies and procedures. This role is different because the Regional Quality Operations Specialist at WelbeHealth: Plays a pivotal role in driving quality and compliance across multiple markets, partnering closely with leaders and interdisciplinary teams (IDTs) to elevate care delivery and ensure regulatory excellence. Serves as a key influencer in shaping quality strategy, leading root cause analyses (RCAs), and mentoring new specialists, having an impact beyond that of a traditional compliance role.

Requirements

Must be residing in the State of CA (ideally in Northern CA) as this role may require frequent travel to Stockton, Modesto and Elk Grove based on business needs.
Bachelor’s degree in relevant field; professional experience of five (5) years may be substituted; master’s degree in relevant field preferred
Minimum of two (2) years of experience in QI/assurance
Experience working in a healthcare setting; healthcare or eldercare programs with oversight of quality/compliance required
Experience in working with multidisciplinary teams required
Experience managing data and conducting analyses using software including but not limited to productivity suite software, Smartsheet’s, and Power BI
Experience with Electronic Medical Records, preferably Athena

Nice To Haves

Experience in or knowledge of healthcare compliance, including PACE-specific program compliance, and HIPAA requirements preferred
healthcare and PACE-specific compliance experience

Responsibilities

Partner with QOD and market leadership to implement WelbeHealth’s Quality Improvement (QI) program and on market-level process improvement initiatives
Onboard and mentor new quality specialist team members
Support regulatory process improvement, such as leading RCAs
Conduct additional market-level audits as assigned, as well as review and analyze reports of market-level data including that specified in the QI plan and required by state and federal regulations
Highlight data trends to the QOD, EDs, or market leaders for process improvement opportunities, as well as provide support through the preparation and successful completion of all state, federal, and mock audits
Assist the QOD in monitoring corrective action plans, and in overseeing the preparation, implementation, and follow-up of all QI Program Committees, including the Quality Improvement Committee and Participant Advisory Committee
Organize and gather information for monthly and quarterly CMS meetings with the QOD, ED, Medical Director and other key stakeholders, and act as the liaison to notify regulators of IDT updates such as prospective denial enrollees and involuntary disenrollment requests