Quality Assurance Specialist

Pacific Health Group

Quality Assurance Specialist ensuring compliance and quality across ECM, CS, BH, and CHW operations at Pacific Health Group. Conducting outreach initiatives to engage and enroll eligible members.

Posted 6/11/2026full-timeSan Diego County • California • 🇺🇸 United StatesJuniorMid-Level💰 $27 - $33 per hourWebsite

About the role

Key responsibilities & impact

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
Serve as the internal auditor, workflow analyst, and process-improvement lead for all member-facing activities
Conduct community-based outreach across multiple counties through in-person engagement and digital channels to identify, engage, and enroll eligible members into ECM, CS, BH, and CHW programs
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
Track QA metrics across documentation accuracy, outreach compliance, and verification standards

Requirements

What you’ll need

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

Comp & perks

160 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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

quality assurancecare coordinationcompliance auditingworkflow analysisprocess improvementdocumentation accuracyoutreach compliancerisk evaluationdata analysismetrics tracking

Soft Skills

analytical skillsproblem-solving skillsdocumentation skillscommunication skillsinterpersonal skills

Certifications

Bachelor’s degree in Healthcare AdministrationBachelor’s degree in Public HealthBachelor’s degree in Social Work