Quality Assurance Manager

Pacific Health Group

. Lead, develop, implement, oversee, and continuously improve Pacific Health Group's organization-wide Quality Assurance program.

Posted 10/6/2026full-timeCalifornia • United StatesMid-LevelSenior💰 $78,000 - $82,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in leading and implementing quality assurance programs within healthcare settings, focusing on audit methodologies, quality monitoring, and process improvement. Proficient in developing quality metrics, dashboards, and corrective action plans while ensuring compliance with healthcare standards and regulations.

Highest-signal resume keywords

Quality Assurance Program LeadershipAudit Methodologies DevelopmentHealthcare Quality MonitoringCorrective Action Plan DevelopmentData Analysis and Reporting

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality Assurance PrinciplesDocumentation StandardsProcess Improvement MethodologiesRoot-Cause AnalysisQuality Metrics DevelopmentAudit EvaluationPerformance ReportingWorkflow Adherence MonitoringKPI EstablishmentTrend Analysis

Soft Skills

LeadershipCoachingCommunicationInterpersonal SkillsOrganizational Skills

Tools & Technologies

Microsoft Office SuiteReporting ToolsWorkflow SystemsElectronic Documentation PlatformsQuality Reporting Platforms

Certifications & Qualifications

Quality CertificationHealthcare Auditing CertificationProcess Improvement Certification

Industry Keywords

Healthcare OperationsManaged CareMedi-CalCalAIMBehavioral HealthCommunity Health WorkerHealth Plan AuditsElectronic Health RecordsHealthcare Data SystemsMulti-Program Healthcare Organizations

About the role

Key responsibilities & impact

Lead, develop, implement, oversee, and continuously improve Pacific Health Group's organization-wide Quality Assurance program.
Establish standardized quality expectations, audit methodologies, monitoring processes, scoring criteria, and reporting requirements.
Develop annual and ongoing risk-based quality monitoring plans.
Ensure quality processes are consistently applied across programs and departments.
Maintain QA policies, procedures, audit tools, checklists, workflows, and standard operating procedures.
Maintain readiness for health plan audits, county reviews, monitoring activities, program reviews, and external quality assessments.
Coordinate audit preparation, documentation, submissions, findings, responses, corrective actions, and remediation tracking.
Monitor documentation quality, timelines, workflow adherence, operational accuracy, and program requirements.
Identify documentation trends affecting reimbursement, contractual performance, audit outcomes, member services, or service quality.
Supervise, coach, support, and evaluate assigned Quality Assurance personnel.
Establish KPIs, assign audit workloads, monitor productivity and accuracy, conduct meetings, and address performance deficiencies.
Lead audit calibration sessions and standardize audit interpretation, scoring, guidance, and reference materials.
Provide objective, actionable feedback and corrective strategies to department managers.
Develop and deliver training on documentation standards, quality requirements, audit expectations, payer updates, and workflows.
Develop and maintain quality dashboards, scorecards, reports, and tracking systems.
Validate QA data and analyze trends, recurring deficiencies, systemic risks, and root causes.
Provide routine quality performance reports and timely escalation reports to the Directors of Community Health & Operations.
Collaborate with Operations, Revenue Cycle, Finance, Information Technology, Human Resources, Learning & Development, and program leadership.
Support new-program and operational readiness, process improvements, root-cause analysis, and continuous improvement initiatives.
Track corrective actions through completion and verify sustained improvement.
Maintain QA independence and objectivity while escalating significant quality concerns.

Requirements

What you’ll need

Bachelor's degree in Healthcare Administration, Public Health, Business Administration, Social Services, or a related field.
Minimum four (4) years of progressive experience in quality assurance, auditing, healthcare operations, managed care, or a related healthcare or human services environment.
Minimum two (2) years of leadership, supervisory, or quality team oversight experience.
Demonstrated experience conducting audits and evaluating documentation, workflows, and operational quality.
Strong understanding of healthcare quality assurance principles, documentation standards, quality monitoring, and process improvement methodologies.
Experience developing corrective action plans and monitoring improvement through resolution.
Strong analytical skills, including pattern identification, root-cause analysis, and translating findings into actionable recommendations.
Demonstrated ability to develop and monitor quality metrics, dashboards, and performance reports.
Strong leadership, coaching, communication, and interpersonal skills.
Ability to provide objective feedback and influence leaders and staff across multiple departments.
Excellent written and verbal communication skills.
Strong organizational skills and attention to detail.
Ability to manage multiple priorities, deadlines, audits, and improvement initiatives simultaneously.
Proficiency with Microsoft Office Suite, reporting tools, workflow systems, and electronic documentation platforms.
Must maintain confidentiality and safeguard member, employee, quality, payer, and protected health information.
Preferred: Experience with Medi-Cal, California managed care organizations, CalAIM, Enhanced Care Management, Community Supports, Community Health Worker, Behavioral Health, care management, community-based healthcare programs, health plan/county/payer audits, electronic health records, healthcare data systems, quality reporting platforms, payer requirements, or multi-program healthcare organizations.
Quality, healthcare, auditing, or process-improvement certification preferred.

Benefits

Comp & perks

160 Hours of Paid Time Off (PTO)
12 Paid Holidays, including Birthday Holiday
One Floating Holiday after one year of employment
Four (4) Paid Volunteer Hours per Month
Bereavement Leave, including Pet Bereavement Leave
90% Employer-Paid Employee-Only Medical Coverage
Dental and Vision Insurance
Flexible Spending Account (FSA)
Short-Term Disability, Long-Term Disability, and AD&D Coverage
Employee Assistance Program (EAP)
401(k) with Company Match
Monthly Stipend
Professional Development Opportunities
Career Advancement and Internal Growth Opportunities
Hybrid Work Environment
Quarterly In-Person Team and Company Events
Employee Discount Programs through Great Work Perks and Perks at Work