Senior Clinical Quality Operations Coordinator

Senior Clinical Quality Operations Coordinator

WelbeHealth PACE helps seniors stay in their homes and communities by providing medical care and community-based services. We believe in going the extra mile and aim to make a genuine difference in our participants’ lives.

The Senior Clinical Quality Operations Coordinator provides advanced oversight and coordination of clinical quality review processes across WelbeHealth. This role is accountable for leading and performing high-level clinical chart audits, universe validations, RAI (Requests for Additional Information) and HPMS (Health Performance Management System) submissions, and other compliance-driven activities to ensure accuracy, timeliness, and data integrity. The Senior Clinical Quality Coordinator serves as a resource for clinical quality standards, supports process optimization initiatives, and partners with Quality Operations leadership and clinical teams to uphold exceptional standards of care and documentation compliance.

This role is different because the Senior Clinical Quality Operations Coordinator at WelbeHealth:

• Operates at the intersection of clinical care and regulatory compliance, directly influencing audit readiness, CMS reporting (RAI/HPMS), and the integrity of clinical documentation that impacts participant outcomes
• Serves as a clinical quality leader and mentor, driving process improvements while partnering with interdisciplinary teams to elevate documentation standards and audit performance across the organization

We care about our team members. That’s why we offer:

• Medical insurance coverage (Medical, Dental, Vision)
• Work/life balance - We mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days
• 401K savings + match
• Comprehensive compensation package including base pay and bonus
• And additional benefits!

On the day-to-day, you will:

• Lead and perform clinical chart reviews to validate documentation, coding accuracy, and alignment with regulatory and organizational standards
• Conduct clinical audits, ensuring consistent application of standard operations procedures (SOPs), associated policies, audit protocols, tracking metrics, and identifying trends for process improvement
• Manage and oversee RAIs, as well as verify data completeness, timeline adherence, and accuracy
• Assist in the development of compliance tracking tools, scorecards, dashboards, Root Cause Analyses (RCA), and Corrective Action Plans (CAPs) as needed following audits
• Serve as a subject matter resource for clinical data validation
• Collaborate closely with interdisciplinary and regional/onsite clinical teams to resolve documentation discrepancies
• Assist with supporting coordinators on data review protocols and documentation standards, as well as oversee the work of other clinical coordinators to ensure understanding and develop investigation techniques

Job requirements include:

• Licensed clinical professional (e.g., RN, LVN, or equivalent) with four (4) years of experience in clinical documentation and audit processes
• Minimum of one (1) year of experience in a Quality Operations Coordinator role or equivalent experience required
• Proven competency in clinical data systems, such as Smartsheets and HPMS platforms
• Strong analytical and problem-solving skills to interpret and communicate complex clinical data accurately and to identify trends or discrepancies preferred
• Detail-oriented with advanced proficiency in electronic medical record (EMR) navigation and quality reporting tools
• At least two (2) years of experience in a clinical quality review, utilization management, or related healthcare role

We are seeking a Senior Clinical Quality Operations Coordinator who is passionate about clinical excellence, regulatory compliance, and continuous improvement. If you are driven to make a meaningful impact by ensuring the highest standards of clinical documentation and audit readiness in a mission-driven healthcare environment, we’d love to hear from you!

Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications.

Compensation Offering$99,309.58—$131,088.64 USD

Our Commitment to Diversity, Equity and Inclusion

At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

Beware of Scams

Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to fraud.report@welbehealth.com