Senior Quality Operations Specialist, CAP & Monitoring
New
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WelbeHealthHealthcare quality
Location: Remote, USAFull-TimeSenior
SalaryCompensation consists of base salary plus bonus. Compensation Offering $74,612.76 — $98,488.84 USD
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Job Details
- Experience
- Minimum of three (3) years of experience in healthcare quality, compliance, auditing, performance improvement, corrective action management, or related operations; five (5) years of experience preferred
- Required Skills
- Process improvement
Requirements
- Bachelor’s degree in healthcare administration, nursing, public health, business administration, health information management, regulatory affairs, quality management, compliance, or a related field required.
- Master’s degree preferred.
- At least three years of experience in healthcare quality, compliance, auditing, performance improvement, corrective action management, or related operations; five years preferred.
- Experience developing, implementing, monitoring, and sustaining regulatory CAPs.
- Experience with process improvement, risk assessment, and quality improvement methodologies such as PDSA, Lean, or Six Sigma preferred.
- Experience in root cause analysis, PACE, Medicare, Medicaid, managed care, healthcare operations, quality, or compliance preferred.
- Experience developing dashboards, reports, tracking tools, and performance measures; Power BI experience preferred.
- Use a data-driven approach and critical thinking to identify trends, evaluate risks, determine root causes, and develop actionable recommendations.
- Ability to use AI and technology to automate workflows and streamline processes.
- Travel to WelbeHealth centers as needed, including occasional overnight stays.
Responsibilities
- Lead the development, implementation, monitoring, and validation of CAPs resulting from PACE regulatory audits, mock audits, monitoring activities, complaints, and other compliance reviews.
- Identify and escalate risks, overdue actions, implementation challenges, and systemic issues.
- Partner with center and departmental leadership to develop remediation strategies, establish timelines, resolve barriers, and drive timely completion.
- Facilitate CAP meetings, root cause analysis, and remediation workgroups.
- Review documentation, monitoring results, and evidence submissions to assess implementation effectiveness, sustainability, and regulatory compliance.
- Develop and maintain CAP dashboards, tracking tools, reports, and status updates.
- Use data, monitoring results, and performance metrics to identify trends, risks, and improvement opportunities.
- Identify opportunities to use AI and technology to automate workflows and improve operational effectiveness.
- Support PACE regulatory audits, mock audits, complaint investigations, and other Quality Operations initiatives.
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