Medix™
Quality Assurance Specialist (Healthcare) - 248843
Medix™, California, Missouri, United States, 65018
Quality Assurance Specialist (Healthcare) - 248843
This range is provided by Medix™. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
Base pay range $30.00/hr - $33.00/hr
MUST RESIDE IN SOUTHERN CALIFORNIA
Job Title:
Quality Assurance Specialist – Enhanced Care Management (ECM)
Location:
Remote, must reside in Southern California
Department:
Care Management / Quality & Compliance
Reports To:
Director of Quality, ECM Operations, or Compliance (as applicable)
Position Summary
The Quality Assurance (QA) Specialist is responsible for ensuring high-quality, compliant, and consistent execution of Member Coordination and Enhanced Care Management (ECM) workflows. This role integrates quality oversight across assessments, referrals, care coordination, disenrollment, re‑engagement, and documentation practices while supporting CalAIM, Medi‑Cal, and health‑plan requirements.
The QA Specialist conducts audits, delivers training and coaching, produces performance reporting, and drives continuous improvement initiatives to enhance compliance, operational efficiency, and member experience.
Responsibilities :
Conduct quality audits across Member Coordination and ECM workflows, including assessments, referrals, care coordination, disenrollment, re‑engagement, and documentation accuracy.
Ensure ECM program compliance with CalAIM, Medi‑Cal, state, and health‑plan requirements through routine audits and audit support.
Monitor data accuracy, CRM/EMR workflow adherence, closed‑loop referrals, and verification processes across systems.
Deliver training, coaching, and feedback to staff to reinforce documentation standards, compliance requirements, and best practices.
Develop and maintain SOPs, templates, and training materials to support standardized execution.
Produce monthly quality reports and dashboards, track ECM and Member Coordination performance metrics, and identify trends and risks.
Lead corrective action planning and continuous improvement initiatives in collaboration with leadership, compliance, and IT teams.
Support audit readiness and enhance member experience through consistent, compliant care‑management practices.
Required Qualifications :
Bachelors Degree in healthcare administration, public health, social work, or related field.
Minimum of 2+ years of experience in quality assurance, care coordination, compliance, or healthcare program auditing.
Working knowledge of Enhanced Care Management (ECM), CalAIM, Medi‑Cal, HIPAA, and care coordination workflows highly preferred.
Proficiency in CRM/EMR systems and Microsoft Excel (or equivalent reporting tools).
Preferred Qualifications :
Experience supporting state or health‑plan audits.
Familiarity with trauma‑informed care principles.
Experience developing training materials or SOPs.
Background in population health, complex care management, or community‑based services.
Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances)
Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s). )
401k (eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1)
Short Term Disability Insurance.
Term Life Insurance Plan.
We will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
Seniority level Associate
Employment type Full‑time
Job function Quality Assurance and Health Care Provider
Industries: Health and Human Services
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Base pay range $30.00/hr - $33.00/hr
MUST RESIDE IN SOUTHERN CALIFORNIA
Job Title:
Quality Assurance Specialist – Enhanced Care Management (ECM)
Location:
Remote, must reside in Southern California
Department:
Care Management / Quality & Compliance
Reports To:
Director of Quality, ECM Operations, or Compliance (as applicable)
Position Summary
The Quality Assurance (QA) Specialist is responsible for ensuring high-quality, compliant, and consistent execution of Member Coordination and Enhanced Care Management (ECM) workflows. This role integrates quality oversight across assessments, referrals, care coordination, disenrollment, re‑engagement, and documentation practices while supporting CalAIM, Medi‑Cal, and health‑plan requirements.
The QA Specialist conducts audits, delivers training and coaching, produces performance reporting, and drives continuous improvement initiatives to enhance compliance, operational efficiency, and member experience.
Responsibilities :
Conduct quality audits across Member Coordination and ECM workflows, including assessments, referrals, care coordination, disenrollment, re‑engagement, and documentation accuracy.
Ensure ECM program compliance with CalAIM, Medi‑Cal, state, and health‑plan requirements through routine audits and audit support.
Monitor data accuracy, CRM/EMR workflow adherence, closed‑loop referrals, and verification processes across systems.
Deliver training, coaching, and feedback to staff to reinforce documentation standards, compliance requirements, and best practices.
Develop and maintain SOPs, templates, and training materials to support standardized execution.
Produce monthly quality reports and dashboards, track ECM and Member Coordination performance metrics, and identify trends and risks.
Lead corrective action planning and continuous improvement initiatives in collaboration with leadership, compliance, and IT teams.
Support audit readiness and enhance member experience through consistent, compliant care‑management practices.
Required Qualifications :
Bachelors Degree in healthcare administration, public health, social work, or related field.
Minimum of 2+ years of experience in quality assurance, care coordination, compliance, or healthcare program auditing.
Working knowledge of Enhanced Care Management (ECM), CalAIM, Medi‑Cal, HIPAA, and care coordination workflows highly preferred.
Proficiency in CRM/EMR systems and Microsoft Excel (or equivalent reporting tools).
Preferred Qualifications :
Experience supporting state or health‑plan audits.
Familiarity with trauma‑informed care principles.
Experience developing training materials or SOPs.
Background in population health, complex care management, or community‑based services.
Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances)
Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s). )
401k (eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1)
Short Term Disability Insurance.
Term Life Insurance Plan.
We will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
Seniority level Associate
Employment type Full‑time
Job function Quality Assurance and Health Care Provider
Industries: Health and Human Services
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