Senior Director, Eligibility Excellence
WelbeHealth is a value-based healthcare organization that's transforming the future of senior care by providing an all-inclusive care option to our most vulnerable senior population.
The Senior Director, Eligibility Excellence is accountable for driving access, performance, and revenue security through effective oversight of all eligibility related functions. This role owns both long-term platform design and day-to-day operational execution : building scalable systems, optimizing pathways, and managing cross-functional work groups to meet performance targets across enrollment, revenue cycle, and participant experience.
This role is different because the Sr. Director, Eligibility Excellence at WelbeHealth :
- Leads at scale with cross-functional influence, ownership of key systems, and the chance to build lasting solutions
- Advances healthcare innovation by spearheading transformation within a rapidly growing PACE model
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 days401K savings + matchComprehensive compensation package including base pay, bonus, and equityAnd additional benefits!On the day-to-day, you will :
Lead the strategic design and execution of a scalable Eligibility Center of Excellence (CoE), including policy oversight, program segmentation, and end-to-end operational workflows across WelbeHealth's national footprintDirect all day-to-day eligibility operations and performance, including redetermination processing, share of cost oversight and reporting, financial assistance consulting, reconciliation, and participant communications - all with direct accountability for timeliness, accuracy, and complianceEstablish and manage KPIs, dashboards, and audit routines to track performance, monitor regulatory risk, and drive improvement across eligibility operationsBuild and lead a high-performing team, including managers and front-line staff responsible for hiring, training, coaching, and developing talent to consistently meet organizational goalsServe as the executive escalation point for complex eligibility cases and barriers, collaborating with cross-functional leaders to resolve risks and maintain access for participants, while building strong relationships with regulatory partners and advocacy agenciesManage cross-functional partnerships with internal teams such as Enrollment, Finance, Operations, and Compliance, to resolve barriers and ensure participants can access and sustain coverage in a timely, compliant, and seamless mannerDrive enterprise-wide enablement, including internal training, SOPs, and knowledge base managementJob requirements include :
Bachelor's degree required; master's degree in public health, health administration, public policy, or related field preferredMinimum of ten (10) years of experience in California state Medicaid and Medicare eligibility, enrollment operations, health plan administration, or regulatory policy in managed care, state programs, or integrated provider systemsProven experience operating in regulated healthcare environments with direct responsibility for eligibility strategy, policy interpretation, and program executionMinimum of five (5) years of leadership experience managing large or multi-state eligibility teams or enterprise-level platforms, with demonstrated success in meeting performance, access, and compliance goalsStrong command of federal and state Medicaid policy, including SOC, asset testing, redetermination, institutional deeming, and dual eligibility pathwaysMust be willing and able to work a varied schedule that may include evenings, weekends, and overtimeWe are seeking candidates that ideally have previous experience in sales, growth, or a related role. If you're ready to join a holistic care team that values both its participants and team members, we'd love to hear from you!