QA Specialist Care Management

Pacific Health Group; United States; Remote; Full time

Job summary

A leading healthcare organization is seeking a Quality Assurance Specialist to ensure compliance and enhance care quality through audits and training. The role involves collaborating with teams to implement best practices and improve documentation standards. Candidates should possess a relevant bachelor’s degree and experience in quality assurance within healthcare. The position is full-time and offers a remote work option.

Benefits

401(k)

401(k) matching

Dental insurance

Employee assistance program

Employee discount

Flexible spending account

Health insurance

Life insurance

Paid time off

Referral program

Vision insurance

Qualifications

• Minimum 2 years experience in quality assurance or compliance.
• Familiarity with CalAIM ECM guidelines and Medi-Cal regulations.

Responsibilities

• Conduct regular audits of ECM records for compliance.
• Analyze quality data and prepare reports on findings.
• Facilitate training sessions for ECM care teams.

Skills

Analytical

Problem-Solving

Organizational

Communication

Interpersonal

Education

Bachelor’s degree in healthcare administration

Bachelor’s degree in public health

Bachelor’s degree in nursing

Bachelor’s degree in social work

Tools

Microsoft Office Suite

Excel

Job description

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.

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

Examples of Duties:

• Reviewing a sample of ECM participant charts weekly to assess documentation
• accuracy, completeness, and compliance.
• Conducting monthly training sessions for ECM care coordinators on recent policy
• updates and documentation standards.
• Developing corrective action plans based on audit findings and monitoring
• followup actions.
• Preparing quarterly quality assurance reports that outline audit findings,
• corrective actions, and ongoing recommendations for ECM leadership.
• Shadowing care coordinators during member outreach calls to evaluate service
• quality and realtime adherence to scripts.
• Creating and maintaining a monthly dashboard of key quality metrics (e.g.,
• 72hour outreach completion rate, initial Health Needs Assessment completion
• rate, closed loop referral rate) and presenting results to the ECM Quality
• Committee.
• Leading a focused audit on housing related ECM interventions for members
• experiencing homelessness and summarizing findings in an improvement brief.
• Partnering with IT to test and validate new documentation templates in the EHR
• to ensure all required CalAIM data elements are captured correctly.
• Conducting root cause analysis on recurring documentation deficiencies and
• coordinating with team leads to implement preventive solutions.

Job Type: Full-time

Pay: $28.00 - $33.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance

Compensation Package:

• Hourly pay

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work Location: Remote