Quality Assurance Specialist

United States·San Joaquin CountyFull-timemid

Quality Assurance SpecialistLaboratory & Life Sciences

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Quality Assurance SpecialistLaboratory & Life Sciences

What We Offer

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✓Speak with integrity—clear, respectful, and honest in every interaction.

✓Embrace innovation, trying new ideas, learning fast, and improving care.

✓Own our roles, staying accountable for outcomes and documenting accurately.

✓Build genuine connections with members, families, and teammates through empathy and cultural sensitivity.

✓Lead with trust by being consistent, transparent, and following through.

✓Celebrate wins together, recognizing individual and team achievements.

✓Collaborate with purpose, partnering across departments and with community providers to solve problems.

✓Ask for support and offer support, because thriving together is how we serve our members best.

✓Time 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 opportunities.

✓Culture & Perks: Employee discount programs and quarterly in-person events.

Responsibilities

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→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.
→Ensure HIPAA compliance and data integrity across all member-facing processes.

Evaluate ECM, CS, BH, and CHW workflows for accuracy, efficiency, and risk exposure.
Identify trends, documentation gaps, and systemic errors.
Develop corrective action plans and process improvements to enhance operational performance.

Track QA metrics across documentation accuracy, outreach compliance, and verification standards.
Generate reports outlining findings, trends, risk areas, and performance improvements.
Collaborate with leadership to ensure ECM, CS, BH, and CHW QA metric thresholds are consistently achieved.

Partner with BH, CHW, CS, and ECM teams, Outreach, and leadership to reinforce quality standards.
Provide feedback, coaching, and training based on audit findings.
Support implementation of new workflows and regulatory updates.

95%+ documentation accuracy across all workflows.
100% compliance with required outreach standards (minimum 40% field-based).
Accurate verification across all member profiles.
Complete and timely disenrollment cycle documentation.
Consistent achievement of ECM, CS, BH, and CHW QA metric thresholds.

Requirements

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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