QA Specialist Care Management

Position 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.

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.

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.

Key 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.
• Review a sample of ECM participant charts weekly to assess documentation accuracy, completeness, and compliance.
• Conduct monthly training sessions for ECM care coordinators on recent policy updates and documentation standards.
• Develop corrective action plans based on audit findings and monitor follow-up actions.
• Prepare quarterly quality assurance reports that outline audit findings, corrective actions, and ongoing recommendations for ECM leadership.
• Shadow care coordinators during member outreach calls to evaluate service quality and real-time adherence to scripts.
• Create and maintain a monthly dashboard of key quality metrics (e.g., 72-hour outreach completion rate, initial Health Needs Assessment completion rate, closed loop referral rate) and present results to the ECM Quality Committee.
• Lead a focused audit on housing-related ECM interventions for members experiencing homelessness and summarize findings in an improvement brief.
• Partner with IT to test and validate new documentation templates in the EHR to ensure all required CalAIM data elements are captured correctly.
• Conduct root cause analysis on recurring documentation deficiencies and coordinate with team leads to implement preventive solutions.

Required Qualifications

• Bachelor’s degree in healthcare administration, public health, nursing, social work, or a 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 a related discipline.

Benefits & Perks

• 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

Job Details

• Job Type: Full-time
• Pay: $28.00 - $33.00 per hour
• Expected Hours: 40 per week
• Compensation Package: Hourly pay
• Schedule: 8 hour shift, Day shift, Monday to Friday
• Work Location: Remote