Pacific Health Group

Quality Assurance Specialist

Pacific Health Group

full-time

Posted on:

Location Type: Hybrid

Location: Lodi • California • United States

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Salary

💰 $28 - $33 per hour

About the role

  • Ensure quality, compliance, workflow accuracy, and performance excellence across Enhanced Care Management (ECM), Community Supports (CS), Behavioral Health (BH), and Community Health Worker (CHW) operations
  • Audit member records, assessments, and documentation to ensure compliance with ECM, CS, BH, CHW, CalAIM, and Medi-Cal standards
  • Monitor outreach, referral, and disenrollment workflows to ensure adherence to required timelines and regulatory guidelines
  • Evaluate ECM, CS, BH, and CHW workflows for accuracy, efficiency, and risk exposure
  • Develop corrective action plans and process improvements to enhance operational performance
  • Track QA metrics across documentation accuracy, outreach compliance, and verification standards
  • Collaborate with leadership to ensure ECM, CS, BH, and CHW QA metric thresholds are consistently achieved
  • Conduct community-based outreach across multiple counties through in-person engagement and digital channels

Requirements

  • Bachelor’s degree in Healthcare Administration, Public Health, Social Work, or related field
  • 2+ years of experience in quality assurance, care coordination, compliance, or healthcare program auditing
  • Familiarity with ECM, CS, BH, CHW, CalAIM, Medi-Cal, HIPAA, and care coordination workflows
  • Strong analytical and problem-solving skills
  • Excellent documentation, communication, and interpersonal skills
  • Proficiency in CRM/EMR systems and Excel
  • Driver's License and Reliable transportation required for 40% outreach
Benefits
  • 80 hours of Paid Time Off (PTO) and Paid Sick Time
  • 11 paid holidays per year (including birthday)
  • 4 paid volunteer hours per month
  • Bereavement leave (including fur babies)
  • 90% employer-paid employee-only medical benefits
  • Flexible Spending Account (FSA)
  • Short-term & long-term disability, AD&D, and Employee Assistance Program (EAP)
  • 401(k) with company match
  • Professional development and growth opportunities
  • Employee discount programs and quarterly in-person events
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
quality assurancecare coordinationcompliance auditingprocess improvementdata analysisdocumentation accuracyoutreach complianceworkflow evaluationcorrective action planningmetrics tracking
Soft Skills
analytical skillsproblem-solving skillscommunication skillsinterpersonal skillscollaborationorganizational skillsattention to detailleadership