layiq

/la·yiq/adjective

worthy; deserving; fitting; suitable.

A role, opportunity, or path that merits attention, time, and pursuit.

Quality Assurance Specialist at Pacific Health Group | LAYIQ

Quality Assurance & Compliance Oversight
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.
Workflow Analysis & Process Improvement
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.
Performance Monitoring & Reporting
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.
Cross-Functional Collaboration
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.
Success Measures
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.
Skills That Set You Apart
Required Qualifications
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

Quality Assurance Specialist

Employer job description

About Pacific Health Group

Key Responsibilities

Benefits

About this listing