Hybrid Quality Assurance Specialist

at Pacific Health Group

• Job title: Quality Assurance Specialist
• Job type: Full Time
• Experience level: Junior, Mid level
• Salary: $28 - $33 per hour
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Lodi, United States

About the role

• Quality Assurance Specialist responsible for compliance and performance excellence in healthcare operations. Conducting audits, outreach, and collaborating across teams to improve service quality.

Responsibilities

• 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