QA Specialist

PACIFIC HEALTH GROUP • Stockton, CA

2d • $28 - $33 • Hybrid

About The Position

Overview We are seeking a detail-oriented and proactive Quality Assurance Specialist to join our team. In this role, you will be responsible for ensuring the quality and performance of our products through rigorous testing and validation processes. You will work closely with development teams to identify issues, improve product functionality, and ensure that business requirements are met. If you have a passion for quality assurance and a strong technical background, we encourage you to apply. Program Overview: The Enhanced Care Management (ECM) program under California Advancing and Innovating Medi-Cal (CalAIM) seeks to improve health outcomes for high-risk Medi-Cal members by providing coordinated, comprehensive, and person-centered care. Our team is committed to enhancing the quality of care through rigorous quality assurance practices. Position Summary: The QA Specialist will oversee quality assurance processes, ensuring compliance with CalAIM ECM standards, policies, and regulatory requirements. This position involves reviewing ECM services, documentation, reporting, and assisting in audits, training, and continuous improvement initiatives.

Requirements

• Bachelor’s degree in healthcare administration, public health, nursing, social work, or related field.
• Minimum of 2 years experience in quality assurance, compliance, or program auditing within healthcare, preferably with Medi-Cal programs.
• Familiarity with CalAIM ECM guidelines, Medi-Cal regulations, and healthcare compliance standards.
• Strong analytical, problem-solving, and organizational skills.
• Excellent communication and interpersonal skills.
• Proficiency in Microsoft Office Suite, especially Excel and database systems.

Nice To Haves

• Prior experience with Enhanced Care Management or care coordination programs.
• Certification in Quality Assurance, Healthcare Compliance, or related discipline.

Responsibilities

• Conduct regular audits of ECM records and case notes to ensure adherence to program standards and regulatory compliance.
• Identify areas for improvement and collaborate with ECM care teams to implement corrective action plans.
• Analyze quality data and prepare reports highlighting key findings and trends.
• Facilitate training sessions for ECM care teams on documentation practices, compliance, and quality standards.
• Assist in preparation and participation in state and internal audits, ensuring readiness and compliance.
• Review client care plans and interventions to ensure alignment with ECM objectives and CalAIM requirements.
• Collaborate with cross-functional teams to enhance quality outcomes and implement best practices.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level