QA Specialist, Community Supports — Field Audits

Pacific Health Group; Cross Lanes (WV); Hybrid; USD 37.000 - 45.000; Vollzeit

Benefits dieser Stelle

PTO & Holidays

Health benefits

401(k) with company match

Professional development

Discount programs

Zusammenfassung

The position includes at least 40% field outreach and site audits, with HIPAA privacy, CAP development, and cross‑functional collaboration to enhance health equity and care quality.

Qualifikationen

• Bachelor’s degree in Healthcare Administration, Public Health, Social Work, or related field.
• 2+ years in quality assurance, compliance auditing, care coordination quality review, or healthcare program oversight.
• Familiar with CalAIM Community Supports (CS), ECM, Medi-Cal guidelines, HIPAA, and MCP audit requirements.
• Strong written, analytical, and interpersonal skills with experience giving feedback and training.
• Proficiency with EMR/EHR platforms, CRM systems, and Microsoft Excel.

Aufgaben

• Audit CS member files, authorizations, and service plans for CalAIM, DHCS, and MCP standards.
• Audit CS service lines for housing, meals, recuperative care, and home adaptations.
• Verify eligibility assessments, authorizations, and disenrollment timelines.
• Ensure HIPAA privacy, consent protocols, and privacy across CS platforms.

Ausbildung

Bachelor’s degree in Healthcare Administration, Public Health, Social Work, Quality Management, or a related field

Jobbeschreibung

The position includes at least 40% field outreach and site audits, with HIPAA privacy, CAP development, and cross‑functional collaboration to enhance health equity and care quality.