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Director, HPS Regulatory Operations

2 weeks, 2 days ago
United States
Full-time
Lead
Compliance Manager
Operations
Apply Now
WelbeHealth

WelbeHealth

WelbeHealth is a full-service healthcare company that offers personalized support to help seniors age well at home and in their community. Their Program of All-Inclusive Care for the Elderly (PACE) provides comprehensive services at no cost, including ...

Family Services
251-1K
Founded 2015
$31M raised
View All Jobs 16

Description

  • Lead and oversee all regulatory operations activities within Health Plan Services to ensure compliance with federal, state, and contractual requirements.
  • Translate regulatory requirements into clear operational processes, controls, and governance structures.
  • Serve as the operational owner for regulatory intake, triage, tracking, response coordination, and closure.
  • Establish and maintain a centralized regulatory operations framework with workflows, escalation paths, service-level expectations, and documentation standards.
  • Oversee regulatory requests, inquiries, complaints, audits, and examinations from agencies and oversight entities.
  • Own and maintain a regulatory issue log and tracking system to support timely responses, trend analysis, and leadership visibility.
  • Lead operational readiness for routine and ad hoc audits, surveys, and examinations.
  • Partner with functional leaders to keep audit artifacts, SOPs, and evidence current, accurate, and accessible.
  • Identify root causes from audit findings and regulatory issues, drive corrective action plans, and report remediation status to executives.
  • Develop and maintain SOPs, workflows, control documentation, templates, and response formats to improve scalability and support growth and multi-state expansion.
  • Proactively identify regulatory and operational risks, analyze trends and complaint drivers, and recommend mitigation strategies.
  • Manage direct reports, including hiring, training, supervising, and mentoring.

Requirements

  • Bachelor’s degree in healthcare administration, public health, business administration, regulatory affairs, or a related field required.
  • Master’s degree in healthcare administration, public health, or a related field preferred.
  • Formal training or certification in compliance, regulatory affairs, quality, or audit disciplines preferred.
  • Minimum of 8 years of progressive experience in healthcare regulatory operations, compliance operations, audit management, or health plan administration.
  • Minimum of 2 years of people leadership experience with demonstrated ability to mentor and develop teams.
  • Strong working knowledge of Medicare, Medicaid, and managed care regulatory environments.
  • Multiple-state knowledge and experience with Medicare and Medicaid in California, New Jersey, and New York desired.
  • Demonstrated experience translating regulatory requirements into operational processes and controls.
  • Experience operating in a data-driven environment and leveraging metrics to manage performance and risk.
  • Excellent written and verbal communication skills, including drafting regulatory responses and executive-level summaries.
  • Must be willing and able to work a varied schedule, including evenings, nights, weekends, and overtime.

Benefits

  • Medical, dental, and vision insurance coverage.
  • 17 days of personal time off, 12 observed holidays, and 6 sick days.
  • 401(k) savings plan with company match.
  • Base salary plus bonus.
  • Competitive total rewards package with comprehensive healthcare coverage and additional benefits.
  • Compensation range of $159,939.07 to $211,119.57 USD.
  • Vaccination policy with proof of vaccination or a vaccine declination form required prior to employment.

Interested in this position?

Apply directly on the company website

Apply Now

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