Pacific Health Group
Member Coordinator Quality Assurance Specialist
Pacific Health Group, California, Missouri, United States, 65018
At
Pacific Health Group,
we're transforming healthcare by connecting people to the care and community resources they deserve. Our mission is to improve health outcomes by addressing social determinants of health and coordinating comprehensive, community-based services.
If you're passionate about making a difference and thrive in a collaborative, community-focused environment, we'd love to have you on our team.
Overview This Member Coordinator Quality Assurance Specialist ensures quality, compliance, workflow accuracy, and performance excellence across both Enhanced Care Management (ECM) and Member Coordination operations. The QA Specialist serves as the internal auditor, workflow analyst, and process‑improvement lead for all member‑facing activities, including assessments, referrals, documentation, disenrollment workflows, re‑engagement processes, outreach, verification, and communication functions. This position strengthens operational integrity, ensures regulatory compliance, and builds a culture of accountability and continuous improvement within the newly developed QA unit.
This role is entirely remote, but we have a preference for applicants located in the Southern California region.
Employment Type:
Full time
Start Date:
ASAP
Hourly Rate:
$30 - $33 per hour
Expectations of success
95%+ documentation accuracy across all workflows
100% compliance with required outreach standards
Accurate verification across all member profilesComplete and timely disenrollment cycle documentation
Consistent achievement of ECM QA metric thresholds
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, 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
Time Off & Leave
160 Hours of Paid Time Off (PTO)
12 Paid Holidays per year, including your birthday and one floating holiday after 1 year of employment
4 Paid Volunteer Hours per Month to support causes you care about
Bereavement Leave, including Fur Baby Bereavement
Health & Wellness
90% Employer‑paid Employee‑Only Medical Benefits
Flexible Spending Account (FSA)
Short‑Term & Long‑Term Disability | AD&D
Employee Assistance Program (EAP)
Financial & Professional
401(k) with Company Match
Monthly Stipend
Opportunities for professional development and internal growth
Culture & Perks
Employee Discounts via Great Work Perks and Perks at Work
Quarterly In‑Person Events
Equal Opportunity Employer Pacific Health Group is an Equal Opportunity Employer. We are committed to creating an inclusive and equitable workplace where all individuals are treated with dignity and respect. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex (including pregnancy, childbirth, breastfeeding, and related medical conditions), gender, gender identity or gender expression, sexual orientation, national origin or ancestry, citizenship status, physical or mental disability, medical condition (including cancer and genetic characteristics), age (40 and over), marital status, military or veteran status, genetic information, or status as a victim of domestic violence, assault, or stalking. We value diversity in all forms and encourage individuals from historically underrepresented communities to apply.
Job Application & Offer Disclaimer Pacific Health Group is committed to maintaining a transparent, lawful, and secure hiring process in compliance with California labor laws and employment standards. No candidate will be offered employment without meeting the required qualifications and skillset for the position and successfully completing all steps of our recruitment process, which include:
Submission of a completed internal application via our HRIS system
A formal pre‑screen with our recruiting team
Completion of a skills assessment (if applicable to the position)
Participation in a final interview with hiring leadership
Receipt of a formal verbal offer from our authorized hiring team
AI & Human Interaction (HI) in Recruitment Pacific Health Group is committed to fairness, equity, and transparency in our hiring practices. We use AI (Artificial Intelligence) tools to help match candidate resumes against our job descriptions, focusing on qualifications, skillsets, and location.
All resumes that meet these criteria are then reviewed by HI (Human Interaction) — our recruiting and HR team. Pacific Health Group remains true to our Equal Employment Opportunity (EEO) statement, ensuring that every candidate is given fair and consistent consideration.
#J-18808-Ljbffr
Pacific Health Group,
we're transforming healthcare by connecting people to the care and community resources they deserve. Our mission is to improve health outcomes by addressing social determinants of health and coordinating comprehensive, community-based services.
If you're passionate about making a difference and thrive in a collaborative, community-focused environment, we'd love to have you on our team.
Overview This Member Coordinator Quality Assurance Specialist ensures quality, compliance, workflow accuracy, and performance excellence across both Enhanced Care Management (ECM) and Member Coordination operations. The QA Specialist serves as the internal auditor, workflow analyst, and process‑improvement lead for all member‑facing activities, including assessments, referrals, documentation, disenrollment workflows, re‑engagement processes, outreach, verification, and communication functions. This position strengthens operational integrity, ensures regulatory compliance, and builds a culture of accountability and continuous improvement within the newly developed QA unit.
This role is entirely remote, but we have a preference for applicants located in the Southern California region.
Employment Type:
Full time
Start Date:
ASAP
Hourly Rate:
$30 - $33 per hour
Expectations of success
95%+ documentation accuracy across all workflows
100% compliance with required outreach standards
Accurate verification across all member profilesComplete and timely disenrollment cycle documentation
Consistent achievement of ECM QA metric thresholds
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, 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
Time Off & Leave
160 Hours of Paid Time Off (PTO)
12 Paid Holidays per year, including your birthday and one floating holiday after 1 year of employment
4 Paid Volunteer Hours per Month to support causes you care about
Bereavement Leave, including Fur Baby Bereavement
Health & Wellness
90% Employer‑paid Employee‑Only Medical Benefits
Flexible Spending Account (FSA)
Short‑Term & Long‑Term Disability | AD&D
Employee Assistance Program (EAP)
Financial & Professional
401(k) with Company Match
Monthly Stipend
Opportunities for professional development and internal growth
Culture & Perks
Employee Discounts via Great Work Perks and Perks at Work
Quarterly In‑Person Events
Equal Opportunity Employer Pacific Health Group is an Equal Opportunity Employer. We are committed to creating an inclusive and equitable workplace where all individuals are treated with dignity and respect. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex (including pregnancy, childbirth, breastfeeding, and related medical conditions), gender, gender identity or gender expression, sexual orientation, national origin or ancestry, citizenship status, physical or mental disability, medical condition (including cancer and genetic characteristics), age (40 and over), marital status, military or veteran status, genetic information, or status as a victim of domestic violence, assault, or stalking. We value diversity in all forms and encourage individuals from historically underrepresented communities to apply.
Job Application & Offer Disclaimer Pacific Health Group is committed to maintaining a transparent, lawful, and secure hiring process in compliance with California labor laws and employment standards. No candidate will be offered employment without meeting the required qualifications and skillset for the position and successfully completing all steps of our recruitment process, which include:
Submission of a completed internal application via our HRIS system
A formal pre‑screen with our recruiting team
Completion of a skills assessment (if applicable to the position)
Participation in a final interview with hiring leadership
Receipt of a formal verbal offer from our authorized hiring team
AI & Human Interaction (HI) in Recruitment Pacific Health Group is committed to fairness, equity, and transparency in our hiring practices. We use AI (Artificial Intelligence) tools to help match candidate resumes against our job descriptions, focusing on qualifications, skillsets, and location.
All resumes that meet these criteria are then reviewed by HI (Human Interaction) — our recruiting and HR team. Pacific Health Group remains true to our Equal Employment Opportunity (EEO) statement, ensuring that every candidate is given fair and consistent consideration.
#J-18808-Ljbffr