Quality Assurance Specialist

Pacific Health Group • Manteca, CA

16d • $28 - $33 • Hybrid

About The Position

The Quality Assurance Specialist ensures quality, compliance, workflow accuracy, and performance excellence across Enhanced Care Management (ECM), Community Supports (CS), Behavioral Health (BH), and Community Health Worker (CHW) operations. The QA Specialist serves as the internal auditor, workflow analyst, and process-improvement lead for all member-facing activities, including assessments, referrals, documentation, disenrollment workflows, re-engagement processes, outreach, verification, and communication functions.
This position strengthens operational integrity, ensures regulatory compliance, and builds a culture of accountability and continuous improvement within the Quality Assurance unit. This role directly impacts documentation accuracy, regulatory compliance, workflow efficiency, and member experience quality across the organization.
Outreach (Minimum 40%)
Conduct community-based outreach across multiple counties through in-person engagement and digital channels (phone, SMS, email, social media) to identify, engage, and enroll eligible members into ECM, CS, BH, and CHW programs. Build and maintain partnerships to expand access to services in high-need communities. A minimum of 40% of this role is dedicated to direct community outreach.

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

Responsibilities

• 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.
• Ensure HIPAA compliance and data integrity across all member-facing processes.
• Evaluate ECM, CS, BH, and CHW workflows for accuracy, efficiency, and risk exposure.
• Identify trends, documentation gaps, and systemic errors.
• Develop corrective action plans and process improvements to enhance operational performance.
• Track QA metrics across documentation accuracy, outreach compliance, and verification standards.
• Generate reports outlining findings, trends, risk areas, and performance improvements.
• Collaborate with leadership to ensure ECM, CS, BH, and CHW QA metric thresholds are consistently achieved.
• Partner with BH, CHW, CS, and ECM teams, Outreach, and leadership to reinforce quality standards.
• Provide feedback, coaching, and training based on audit findings.
• Support implementation of new workflows and regulatory updates.

Benefits

• Time Off & Leave: 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).
• Health & Wellness: 90% employer-paid employee-only medical benefits; Flexible Spending Account (FSA); Short-term & long-term disability, AD&D, and Employee Assistance Program (EAP).
• Financial & Professional: 401(k) with company match; Professional development and growth opportunities.
• Culture & Perks: Employee discount programs and quarterly in-person events.

What This Job Offers

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