Regional Quality Operations Specialist

Job Description

Job Description

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

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, bonus, and equity
• And additional benefits!

On the day-to-day, you will:

• 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

Job requirements include:

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

We are seeking a Regional Quality Operations Specialist that ideally has healthcare and PACE-specific compliance experience. If you're ready to join a team that values both its participants and team members, we'd love 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

$74,612.76—$98,488.84 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 View email address on ziprecruiter.com