Quality Assurance Specialist – Community Supports

Pacific Health Group

. Conduct community- and site-based outreach and auditing across target counties .

Posted 10/13/2026full-timeCalifornia • United StatesJuniorMid-Level💰 $56,160 - $68,640 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in quality assurance and compliance auditing within healthcare programs, with a strong focus on CalAIM Community Supports, HIPAA regulations, and effective service delivery workflows. Proficient in analyzing documentation for compliance and formulating corrective action plans to enhance operational efficiency.

Highest-signal resume keywords

Quality AssuranceCompliance AuditingCalAIM Community SupportsEMR/EHR ProficiencyHealthcare Program Oversight

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality ManagementCompliance AnalysisService Delivery EvaluationDocumentation AuditingData TrackingCorrective Action PlanningWorkflow AnalysisAuthorization ReviewBilling Discrepancy TrackingMember Eligibility Verification

Soft Skills

Analytical SkillsInterpersonal SkillsWritten CommunicationFeedback DeliveryTraining Experience

Tools & Technologies

EMR SystemsEHR PlatformsCRM SystemsMicrosoft Excel

Industry Keywords

HIPAA ComplianceManaged Care PlanCommunity-Based OrganizationsHealthcare AdministrationPublic HealthSocial WorkQuality ReviewMedi-Cal GuidelinesEnvironmental ModificationsHousing Transition

About the role

Key responsibilities & impact

Conduct community- and site-based outreach and auditing across target counties
Perform field-based audits of contracted Community Supports vendors/CBOs
Evaluate physical compliance, including housing or environmental modification standards
Verify member service delivery directly in the field
Conduct outreach to community partners to align quality standards
Audit Community Supports member files, authorization requests, and individual service plans for CalAIM, DHCS, and Managed Care Plan compliance
Audit documentation for Housing Transition/Tenancy, Medically Tailored Meals, Recuperative Care, and Environmental Adaptations
Verify member eligibility assessments, authorizations, and disenrollment workflows meet required timelines and regulations
Ensure adherence to HIPAA, member consent protocols, and privacy standards
Evaluate CS intake, referral, authorization, and service delivery workflows
Track error trends, documentation deficiencies, and billing/invoice discrepancies
Formulate Corrective Action Plans and lead process-improvement initiatives
Monitor contracted providers and CBO partners to verify services match billed claims and care plans
Collaborate on provider invoice reconciliations before submission to Managed Care Plans
Track CS quality metrics, audit scorecards, assessment timeliness, authorization pass rates, and documentation accuracy
Generate compliance reports for program leadership
Partner with CS Coordinators, ECM leads, and operational managers to provide feedback, coaching, and training

Requirements

What you’ll need

Bachelor’s degree in Healthcare Administration, Public Health, Social Work, Quality Management, or a related field
2+ years of experience in quality assurance, compliance auditing, care coordination quality review, or healthcare program oversight
Direct familiarity with CalAIM Community Supports (CS) service definitions, ECM, Medi-Cal guidelines, HIPAA, and Managed Care Plan audit requirements
Proven ability to analyze complex healthcare/social service workflows and audit EMR/CRM documentation for compliance gaps
Strong written, analytical, and interpersonal skills, with experience delivering constructive feedback and training to operational teams
Proficiency with EMR/EHR platforms, CRM systems, and Microsoft Excel (data tracking, audit log management)
Valid Driver's License, active auto insurance, and reliable transportation required for 40% field visits and site audits

Benefits

Comp & perks

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)
90% employer-paid employee-only medical benefits
Flexible Spending Account (FSA)
Short-term and long-term disability
AD&D
Employee Assistance Program (EAP)
401(k) with company match
Professional development and growth opportunities
Employee discount programs
Quarterly in-person events