Quality Assurance Manager

Pacific Health Group; California; Hybride; USD 78 000 - 82 000; Plein temps

Résumé du poste

Pacific Health Group in California offers a Hybrid Work Environment and seeks a seasoned Quality Assurance Manager to lead the organization-wide QA program. You will develop, implement, and continually improve processes, establish audit methodologies, and drive adherence to regulatory and payer requirements across ECM, CS, CHW services, and related departments.

The role provides direct supervision of QA staff, partners with Directors of Community Health & Operations, and collaborates with

Qualifications

• Lead the organization-wide Quality Assurance program.
• Establish quality standards and audit methodologies.
• Oversee documentation quality and processes.
• Supervise QA personnel and foster performance improvement.

Responsabilités

• Develop, implement, manage, and continuously improve PHG's organization-wide Quality Assurance program
• Establish standardized quality expectations, audit methodologies, monitoring processes, scoring criteria, and reporting requirements
• Maintain Quality Assurance policies, procedures, audit tools, checklists, workflows, and standard operating procedures
• Provide direct supervision, leadership, coaching, and support to assigned Quality Assurance personnel
• Monitor staff productivity, audit accuracy, consistency, timeliness, and completion of assigned responsibilities

Connaissances

Quality Assurance

Audits

Leadership

Documentation

Process Improvement

Project Management

Description du poste

• Hybrid Work Environment

Department: Quality Assurance

Reports To: Directors of Community Health & Operations

Classification: Exempt

Work Arrangement: Hybrid - California Based

Schedule: Monday - Friday | 8:30 AM - 5:00 PM

Compensation: 78k - 82k annually

About Pacific Health Group

Pacific Health Group (PHG) is committed to improving health outcomes by addressing the medical, behavioral, and social needs of the communities we serve. Through programs such as Enhanced Care Management (ECM), Community Supports (CS), Community Health Worker (CHW) services, Behavioral Health, and other community-based healthcare programs, PHG works collaboratively with health plans, providers, community organizations, and other partners to support whole-person care.Our work is grounded in accountability, collaboration, innovation, integrity, and a commitment to improving access to high-quality services for vulnerable and underserved populations.

Position Summary

The Quality Assurance (QA) Manager is responsible for the leadership, development, implementation, oversight, and continuous improvement of Pacific Health Group's organization-wide Quality Assurance program.

This position provides quality oversight across PHG programs and operational departments, including Enhanced Care Management (ECM), Community Supports (CS), Community Health Worker (CHW) services, Behavioral Health, Revenue Cycle, Outreach, and other organizational functions as assigned.

The QA Manager ensures that services, documentation, workflows, and operational practices align with applicable health plan requirements, contractual obligations, regulatory standards, internal policies and procedures, and established PHG quality expectations.

The QA Manager leads routine and targeted audits, develops quality metrics and dashboards, identifies trends and systemic risks, oversees corrective action follow-up, strengthens operational workflows, and works collaboratively with department managers to improve quality, accuracy, consistency, and adherence to applicable requirements.

This position provides direct leadership and oversight to assigned Quality Assurance personnel and serves as a key quality resource to the Directors of Community Health & Operations and departmental leadership.

The QA Manager is expected to operate proactively and independently within the scope of the position. Quality concerns should be identified through established monitoring and auditing processes rather than solely through leadership escalation.

Essential Duties And Responsibilities

Quality Assurance Program Management

• Develop, implement, manage, and continuously improve PHG's organization-wide Quality Assurance program
• Establish standardized quality expectations, audit methodologies, monitoring processes, scoring criteria, and reporting requirements
• Develop annual and ongoing quality monitoring plans based on organizational priorities, payer requirements, identified risks, audit findings, and performance trends
• Ensure quality processes are consistently applied across applicable programs and departments
• Establish clear standards for documentation quality, workflow adherence, operational accuracy, timeliness, and applicable quality requirements
• Evaluate existing workflows and recommend improvements designed to reduce errors, strengthen accountability, and improve service delivery
• Maintain Quality Assurance policies, procedures, audit tools, checklists, workflows, and standard operating procedures
• Ensure QA processes evolve as payer, contractual, regulatory, program, and organizational requirements change
• Establish risk-based monitoring strategies that prioritize high-risk programs, requirements, workflows, or identified areas of concern

Health Plan, County & External Audit Readiness

• Maintain organizational readiness for health plan audits, county reviews, monitoring activities, program reviews, and other external quality assessments within QA's scope
• Coordinate preparation for external audits and reviews
• Review applicable documentation and records in advance of scheduled audits when appropriate
• Coordinate with department leadership to ensure required materials are accurate, complete, organized, and available
• Maintain centralized tracking of upcoming audits, requested documentation, submission deadlines, findings, and required responses
• Track external audit findings and required corrective actions
• Support development and coordination of responses to health plan, county, or external quality findings
• Monitor completion of remediation activities following external reviews
• Maintain organized records of audit requests, submissions, findings, responses, corrective actions, and supporting documentation
• Identify trends across external reviews and recommend organization-wide improvements when appropriate
• Promptly communicate significant audit findings or risks to the Directors of Community Health & Operations

Documentation & Program Quality

• Maintain working knowledge of documentation and quality requirements applicable to PHG's contracted programs and services
• Monitor adherence to established documentation timelines and quality standards
• Evaluate whether documentation appropriately reflects services provided and established program requirements
• Identify documentation trends that may affect reimbursement, contractual performance, audit outcomes, member services, or quality of service
• Collaborate with program leadership to correct documentation deficiencies and strengthen workflows
• Communicate significant changes in quality or documentation requirements to affected departments
• Develop standardized tools, checklists, and guidance to promote consistent documentation practices
• Partner with Revenue Cycle when documentation deficiencies may affect billing or reimbursement while maintaining clear departmental ownership of Revenue Cycle functions

Quality Team Leadership & Performance Management

• Provide direct supervision, leadership, coaching, and support to assigned Quality Assurance personnel
• Establish clear individual and departmental performance expectations and KPIs
• Assign and monitor audit responsibilities, workloads, priorities, and deadlines
• Conduct regular one-on-one meetings and QA team meetings
• Monitor staff productivity, audit accuracy, consistency, timeliness, and completion of assigned responsibilities
• Conduct performance evaluations and provide ongoing coaching and professional development