Director, Quality Operations (Audit)

This Director opening will specifically lead our Audit team within Quality Operations 

The WelbeHealth PACE program helps seniors stay in their homes and communities by providing all-inclusive medical care and community-based services. We serve the most vulnerable seniors with better quality and compassion in a value-based model.

The Director, Quality Operations (Audit) develops and implements an effective and robust PACE quality program that ensures WelbeHealth participants are uniquely cared for. As a compliance leader and care excellence driver, the Director, Quality Operations (Audit) oversees activities, leads the audit teams, and effectively communicates quality results to team members, the board and its committees, and regulatory agencies. The Director, Quality Operations (Audit) continuously identifies education and training opportunities to improve the performance of WelbeHealth program team members.

Essential Job Duties:

• Collaborate with 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
• Partner with Analytics and Operations Support and Strategy teams to analyze and review operational performance for continuous process improvements, increased efficiency, and greater participant satisfaction
• Monitor and analyze data including plan metrics, HPMS entries, company and market initiatives, and corrective action plans to identify trends and areas for process improvement
• Collaborate with WelbeHealth’s Compliance team on initiatives to monitor and improve compliance issues, corrective action plans, and the Fraud, Waste, and Abuse program
• 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
• Ensure successful implementation and follow up for all Program Committees, including but not limited to the Quality Improvement Committee and Participant Advisory Committee
• Frequent travel to our WelbeHealth centers will be required based on business needs.

Job Requirements:

• Bachelor’s degree in relevant field; professional experience may be substituted; master’s degree in relevant field preferred
• Five (5) years of experience specifically within Audit, three (3) years must be experience as a Quality/assurance director or manager in a healthcare setting, or directing health or elder care programs with oversight of QI or compliance
• Two (2) years of supervisory experience with demonstrated ability to mentor and develop team members
• Formal Quality Improvement and Analytics Certifications preferred
• Experience in or knowledge of health care compliance, including WelbeHealth-specific program compliance and HIPAA requirements, strongly preferred
• 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 as Lean Six Sigma green belt or black belt preferred

Benefits of Working at WelbeHealth: Apply your operational expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.

• 401k + employer match
• Medical insurance coverage (Medical, Dental, Vision) starting day one of employment
• Work life balance – we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, sick time
• And additional benefits