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 days
• 401K savings + match
• Comprehensive compensation package including base pay, bonus, and equity
• And 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 footprint
• Direct 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 compliance
• Establish and manage KPIs, dashboards, and audit routines to track performance, monitor regulatory risk, and drive improvement across eligibility operations
• Build and lead a high-performing team, including managers and front-line staff responsible for hiring, training, coaching, and developing talent to consistently meet organizational goals
• Serve 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 agencies
• Manage 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 manner
• Drive enterprise-wide enablement, including internal training, SOPs, and knowledge base management

Job requirements include:

• Bachelor’s degree required; master’s degree in public health, health administration, public policy, or related field preferred
• Minimum 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 systems
• Proven experience operating in regulated healthcare environments with direct responsibility for eligibility strategy, policy interpretation, and program execution
• Minimum 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 goals
• Strong command of federal and state Medicaid policy, including SOC, asset testing, redetermination, institutional deeming, and dual eligibility pathways
• Must be willing and able to work a varied schedule that may include evenings, weekends, and overtime

We 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!

COVID-19 Vaccination Policy

At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.

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