Employment Type: Full-TimeCompensation: $27 - $33 per hourSchedule: Full-TimeWork Environment: Hybrid / Minimum 40% OutreachLocation: Hybrid within hiring countyAbout Pacific Health GroupAt Pacific Health Group, we care deeply about the people and communities we serve. We meet individuals with kindness, respect, and understanding—listening first, honoring each person's journey, and offering support without judgment.Through compassionate, person-centered healthcare, behavioral health services, and social supports, we walk alongside people as they work toward healing, stability, and a healthier, more hopeful life.Our Core ValuesSpeak with integrity—clear, respectful, and honest in every interactionEmbrace innovation, trying new ideas, learning fast, and improving careOwn our roles, staying accountable for outcomes and documenting accuratelyBuild genuine connections with members, families, and teammates through empathy and cultural sensitivityLead with trust by being consistent, transparent, and following throughCelebrate wins together, recognizing individual and team achievementsCollaborate with purpose, partnering across departments and with community providers to solve problemsAsk for support and offer support, because thriving together is how we serve our members bestRole Overview & ImpactThe 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.Key ResponsibilitiesQuality Assurance & Compliance OversightAudit member records, assessments, and documentation to ensure compliance with ECM, CS, BH, CHW, CalAIM, and Medi‑Cal standardsMonitor outreach, referral, and disenrollment workflows to ensure adherence to required timelines and regulatory guidelinesEnsure HIPAA compliance and data integrity across all member‑facing processesWorkflow Analysis & Process ImprovementEvaluate ECM, CS, BH, and CHW workflows for accuracy, efficiency, and risk exposureIdentify trends, documentation gaps, and systemic errorsDevelop corrective action plans and process improvements to enhance operational performancePerformance Monitoring & ReportingTrack QA metrics across documentation accuracy, outreach compliance, and verification standardsGenerate reports outlining findings, trends, risk areas, and performance improvementsCollaborate with leadership to ensure ECM, CS, BH, and CHW QA metric thresholds are consistently achievedCross‑Functional CollaborationPartner with BH, CHW, CS, and ECM teams, Outreach, and leadership to reinforce quality standardsProvide feedback, coaching, and training based on audit findingsSupport implementation of new workflows and regulatory updatesSuccess Measures95%+ documentation accuracy across all workflows100% compliance with required outreach standards (minimum 40% field‑based)Accurate verification across all member profilesComplete and timely disenrollment cycle documentationConsistent achievement of ECM, CS, BH, and CHW QA metric thresholdsRequirementsBachelor's degree in Healthcare Administration, Public Health, Social Work, or related field2+ years of experience in quality assurance, care coordination, compliance, or healthcare program auditingFamiliarity with ECM, CS, BH, CHW, CalAIM, Medi‑Cal, HIPAA, and care coordination workflowsStrong analytical and problem‑solving skillsExcellent documentation, communication, and interpersonal skillsProficiency in CRM/EMR systems and ExcelDriver's License and Reliable transportation required for 40% outreachBenefitsTime Off & Leave: 160 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 opportunitiesCulture & Perks: Employee discount programs and quarterly in‑person events#J-18808-Ljbffr