Director, Quality Operations

WelbeHealth; United States; Remote; USD 160,000 - 211,000; Full time

Benefits offered by this job

Medical insurance coverage (Medical, R

PTO: 17 days

Holidays: 12

Sick days: 6

401K savings + match

Comprehensive compensation package

Additional benefits

Job summary

WelbeHealth seeks a Director, Quality Operations to lead enterprise-wide quality programs in PACE, driving safety, compliance, and care outcomes. You will partner with Analytics, Compliance, and Operations to translate data into improvements, develop scalable processes, and elevate quality across the organization.

The role requires deep QA/QI leadership, strong regulatory experience with California DHCS and CMS, and a proven ability to mentor teams while advancing performance and participant

Qualifications

• Bachelor’s degree in relevant field; master’s preferred
• Lean Six Sigma green/black belt preferred; QI analytics certifications preferred
• Five years in healthcare QI/assurance or managed health/elder care programs with QI/compliance oversight
• Three years of supervisory experience with mentoring
• Experience with California DHCS regulatory expectations and PACE regulations
• Regulatory audits preparation and response experience
• Experience building, managing, and monitoring CAPs and quality improvement plans
• Experience using data analytics tools including Excel and Power BI

Responsibilities

• Develop and standardize enterprise metrics in clinical excellence, quality, and patient safety
• Create standardized quality operations workflows, playbooks, and data collection tools
• Analyze performance with Analytics and Performance Excellence teams for improvements
• Monitor HPMS, CMS calls, enrollment denials, and audit requirements for trends and actions
• Lead QI initiatives and collaborate on compliance improvements with the Compliance team
• Ensure timely investigation and documentation of PACE program complaints and grievances
• Support regulator requirements and quality reporting across state and federal programs

Skills

Quality operations leadership

Data analysis & visualization

Regulatory compliance

Cross-functional collaboration

Program management

Education

Bachelor’s degree in relevant field

Master’s degree preferred

Tools

Power BI

Excel

HPMS reporting tools

CAPs tracking system

Job description

***Candidates must reside in California, preferably in Northern California or within a 2-hour direct flight of Sacramento, with the ability to travel onsite as needed for business and regulatory requirements***

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

We care about our team members. That’s why we offer:

• Medical insurance coverage (Medical, Dental, Vision)
• Work/life balance - We mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days
• 401K savings + match
• Comprehensive compensation package including base pay and bonus
• And additional benefits!

On the day-to-day, you will:

• 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

Job requirements include:

• Bachelor’s degree in relevant field; professional experience may be substituted; master’s degree in relevant field preferred
• Experience as Lean Six Sigma green belt or black belt preferred; formal QI and analytics certifications preferred
• 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 working with and implementing PACE regulations 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 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

We are seeking a Director, Quality Operations who is passionate about advancing quality, driving compliance, and leading high-impact initiatives that improve participant outcomes and strengthen organizational performance. Ifyou’reready to join a team that values both its participants and team members,we’dlove to hear from you!

Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications.

Compensation Offering$159,939.07—$211,119.57 USD

COVID-19 Vaccination Policy

At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.

Our Commitment to Diversity, Equity and Inclusion

At WelbeHealth, we embrace and cherish the diversity of our team members, and we’re committed to building a culture of inclusion and belonging. We’re proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

Beware of Scams

Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to [e-mail]