Director, Quality Operations
New
W
WelbeHealthHealthcare
Remote, CA, USAFull-TimeDirector
Salary159,939.07 - 211,119.57 USD per year
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Job Details
- Experience
- 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
- Required Skills
- Microsoft Power BIMicrosoft Excel
Requirements
- 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
Responsibilities
- 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
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