Director, HPS Regulatory Operations

At WelbeHealth, we serve our communities’ most vulnerable seniors through shared intention, pioneering spirit, and the courage to love. These core values and our participant-focus lead the way no matter what. The Director, HPS Regulatory Operations is accountable for leading, coordinating, and overseeing all regulatory operations activities within Health Plan Services (HPS) to ensure WelbeHealth remains compliant, audit‑ready, and operationally aligned with federal, state, and contractual requirements. This role translates regulatory requirements into clear, executable operational processes, and provides strong governance, visibility, and accountability across HPS functions. The Director, HPS Regulatory Operations is a member of the HPS leadership team and facilitates collaborative relationships across WelbeHealth and with external regulators and oversight entities. This role is different because the Director, HPS Regulatory Operations at WelbeHealth: Serves as the operational leader for regulatory readiness across HPS, translating complex federal, state, and contractual requirements into scalable processes, controls, and governance structures that support compliance and organizational growth Partners cross-functionally with Compliance, Government Affairs, Operations, Clinical, Network, Finance, and IT leaders to drive audit readiness, mitigate regulatory risk, and ensure consistent execution of regulatory obligations across multiple markets and lines of business 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: Serve as the operational owner for regulatory intake, triage, tracking, response coordination, and closure across HPS, as well as establish and maintain a centralized regulatory operations framework including workflows, escalation paths, service‑level expectations, and documentation standards Oversee all regulatory requests, inquiries, complaints, audits, and examinations impacting HPS (e.g., DHCS, CMS, state Medicaid agencies, delegated oversight entities), as well as own and maintain a regulatory issue log and tracking system to ensure timely responses, trend analysis, and leadership visibility Lead operational readiness for routine and ad‑hoc audits, surveys, and examinations impacting HPS, as well as partner with HPS functional leaders to ensure audit artifacts, SOPs, and evidence are current, accurate, and readily accessible Identify root causes from audit findings and regulatory issues, drive corrective action plans and sustained process improvements, and provide executive‑level summaries of audit outcomes, risks, and remediation status Lead the development and maintenance of SOPs, workflows, and control documentation for HPS regulatory‑impacted processes, as well as standardize documentation, templates, and response formats to improve quality, efficiency, and scalability, ensuring processes are designed to support future growth, delegation, and multi‑state expansion Proactively identify regulatory and operational risk areas within HPS and recommend mitigation strategies, analyze regulatory trends, complaint drivers, and audit themes to inform leadership decision‑making, and drive continuous improvement initiatives to strengthen controls, reduce variability, and improve response timeliness Manage direct reports including hiring, training, supervising, and mentoring Job requirements include: 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 eight (8) years of progressive experience in healthcare regulatory operations, compliance operations, audit management, or health plan administration Minimum of two (2) years of people leadership experience with demonstrated ability to mentor and develop teams Must have strong working knowledge of Medicare, Medicaid, and managed care regulatory environments; multiple state knowledge and experience with Medicare and Medicaid (CA, NJ, and NY) 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 experience drafting regulatory responses and executive‑level summaries Must be willing and able to work a varied schedule that may include evenings, nights, weekends, and overtime We are seeking a strategic and operationally minded Director, HPS Regulatory Operations who is passionate about building scalable regulatory frameworks, driving audit readiness, and fostering a culture of accountability and continuous improvement. The ideal candidate combines deep healthcare regulatory expertise with strong cross-functional leadership skills and a proactive approach to risk management. If you are excited to help shape regulatory operations that support compliance, organizational excellence, and making a difference in the lives of vulnerable seniors, 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 $159,939.07 — $211,119.57 USD COVID-19 Vaccination Policy At WelbeHealth, our mission is to unlock the full potential of ou