Director, Quality Operations – PACE & Compliance Lead

WelbeHealth, LLC.; United States; On-site; USD 160,000 - 211,000; Full time

Benefits offered by this job

Medical insurance (Medical, Dental, V

PTO and holidays

401K + match

Bonus program

Job summary

WelbeHealth is seeking a Director of Quality Operations to design and drive the enterprise PACE quality program, ensuring participant safety, regulatory readiness, and care excellence. You will translate data into actionable insights and lead cross-functional teams across Analytics, Compliance, and Operations.

In this role, you will standardize quality workflows, monitor CAPs and audits, and collaborate with the VP to develop scalable quality tools and reports, while ensuring compliance with

Qualifications

• Bachelor’s degree in a relevant field; master’s degree preferred.
• Lean Six Sigma green belt or black belt preferred; formal QI and analytics certifications preferred.
• Five years of experience required, three years as a QI/assurance Director/Manager in healthcare or elder care with QI or compliance oversight.
• Three years of supervisory experience with demonstrated ability to mentor and develop team members.
• Hands-on experience with California DHCS and PACE regulations preferred.
• Experience with regulatory compliance and audits, including CMS, DHCS, and other regulatory reviews.
• Demonstrated experience developing, implementing, and managing QI plans in line with regulatory requirements.
• Experience with data analysis using Excel and PowerBI.
• Experience developing, managing, and monitoring CAPs to address compliance and quality issues.

Responsibilities

• Collaborate with the VP, Quality Operations to develop and standardize enterprise quality metrics in clinical excellence and patient safety while aligning with policies, procedures, and regulatory guidelines.
• Develop standardized quality operations workflows, playbooks, tools, and resources; implement scalable data collection and reporting.
• Partner with Analytics and Performance Excellence teams to analyze performance for improvements and participant satisfaction.
• Monitor quality improvement metrics, HPMS entries, and CAPs to identify trends and areas for improvement.
• Serve as QI SMEs on program initiatives; support compliance and fraud, waste, and abuse programs.
• Ensure timely submission of information to regulatory agencies including HPMS and CMS quarterly calls.

Skills

Lean Six Sigma

Data analysis

Leadership

Regulatory compliance

Education

Bachelor’s degree in relevant field

Master’s degree in relevant field

QI/Analytics certifications

Tools

Excel

PowerBI

Job description

WelbeHealth is seeking a Director of Quality Operations to design and drive the enterprise PACE quality program, ensuring participant safety, regulatory readiness, and care excellence. You will translate data into actionable insights and lead cross-functional teams across Analytics, Compliance, and Operations.

In this role, you will standardize quality workflows, monitor CAPs and audits, and collaborate with the VP to develop scalable quality tools and reports, while ensuring compliance with