Pacific Health Group

QA Engineer

• 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

Quality Assurance Specialist

Consultant

• Serve as the primary clinical resource for ECM care teams.
• Provide clinical consultation and guidance to Lead Care Managers, Community Health Workers, Licensed Vocational Nurses, and interdisciplinary team members.
• Review complex member cases and provide recommendations regarding care planning, interventions, risk mitigation, and treatment coordination.
• Participate in interdisciplinary case reviews, case conferences, and care team meetings.
• Assist care teams in identifying clinical risks and developing appropriate intervention strategies.
• Support development of individualized, member-centered care plans that align with CalAIM ECM requirements and member goals.
• Promote evidence-based practices and whole-person care approaches.
• Assist leadership with clinical decision-making and complex case management strategies.

Registered Nurse – Clinical Case Consultant

Human Resources

• Serve as the operational leader of the Human Resources department.
• Partner with the Directors of Operations and executive leadership team to align Human Resources strategies with organizational goals, workforce planning initiatives, and organizational growth strategies.
• Lead, mentor, coach, and develop Human Resources team members while fostering accountability, responsiveness, collaboration, and continuous improvement.
• Establish departmental goals, performance expectations, KPIs, and operational standards.
• Oversee recruitment, onboarding, retention, employee engagement, performance management, and employee lifecycle processes.
• Provide guidance and support regarding employee relations matters, workplace investigations, conflict resolution, corrective actions, and performance concerns.
• Ensure compliance with federal, state, local, and healthcare-specific employment laws and regulations.
• Develop, implement, and maintain Human Resources policies, procedures, and operational best practices.
• Serve as a trusted advisor to organizational leadership on workforce matters and employment-related risks.

Human Resources Manager

Manager

• Manage a caseload of members with complex health and social needs
• Spend approximately 65% of your time in the field (homes, shelters, community settings)
• Conduct in-person visits, assessments, and follow-ups
• Travel locally within hiring county
• Coordinate services across healthcare, behavioral health, and community resources
• Participate in community outreach efforts including events, partnerships, and local engagement
• Provide mentorship and support to other care managers
• Document in real-time or by end of day using internal systems

Quality Assurance Specialist

Registered Nurse – Clinical Case Consultant

Human Resources Manager

Community Support Lead Care Manager