Senior Quality Operations Specialist, CAP & Monitoring

🕒 October 6

🇺🇸 United States – Remote

💵 $74.6k - $98.5k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

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WelbeHealth

WebsiteLinkedInAll Job Openings

501 - 1000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 $30M Series C on 2020-02

Healthcare • Healthcare Insurance

WelbeHealth is a healthcare organization that provides comprehensive medical care and personalized support to help seniors age well at home and in their communities. They offer a Program of All-Inclusive Care for the Elderly (PACE) which includes services such as medical care and coordination, dental, vision and hearing services, in-home care, prescription deliveries, transportation, physical therapy, meals, social activities, and more, often at no cost to eligible seniors. WelbeHealth's dedicated team prioritizes the needs of seniors by offering a coordinated approach to healthcare, ensuring access to highly skilled professionals across various areas of healthcare, and emphasizing patient-centered care. Their goal is to improve the quality of life for seniors by enabling them to live independently with robust support from a multidisciplinary team.

📋 Description

• Lead the development, implementation, monitoring, and validation of CAPs resulting from PACE regulatory audits, mock audits, monitoring activities, complaints, and other compliance-related 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 of corrective actions • 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 continuous improvement opportunities • Identify opportunities to leverage AI and technology to automate workflows and improve operational effectiveness • Support PACE regulatory audits, mock audits, complaint investigations, and other Quality Operations initiatives

🎯 Requirements

• Bachelor’s degree in healthcare administration, nursing, public health, business administration, health information management, regulatory affairs, quality management, compliance, or related field required • Previous experience with process improvement, risk assessment, and quality improvement methodologies (e.g., PDSA, Lean, Six Sigma) preferred • 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 • Experience developing, implementing, monitoring, and sustaining regulatory CAPs • Experience in RCA, PACE, Medicare, Medicaid, managed care, healthcare operations, quality, or compliance preferred • Experience developing dashboards, reports, tracking tools, and performance measures; Power BI experience preferred • Strong data-driven approach and critical-thinking skills, including identifying trends, evaluating risks, determining root causes, and developing actionable recommendations • Ability to use AI and technology to automate workflows, streamline processes, and improve operational efficiency and effectiveness • Travel to WelbeHealth centers as needed to support business-related activities, including occasional overnight stays • Proof of vaccination, or a vaccine declination form, required prior to employment

🏖️ Benefits

• Medical insurance coverage (Medical, Dental, Vision) • 17 days of personal time off (PTO) • 12 holidays observed annually • 6 sick days • 401K savings + match • Comprehensive compensation package including base pay and bonus • Additional benefits