Job Description
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description
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 • 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. 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, 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 Requirements • 95%+ documentation accuracy across all workflows • 100% compliance with required outreach standards • Accurate verification across all member profiles • Complete and timely disenrollment cycle documentation • Consistent achievement of ECM QA metric thresholds Benefits • 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 • 90% Employer-paid Employee-Only Medical Benefits • Flexible Spending Account (FSA) • Short-Term & Long-Term Disability | AD&D • Employee Assistance Program (EAP) • 401(k) with Company Match • Monthly Stipend • Opportunities for professional development and internal growth • Employee Discounts via Great Work Perks and Perks at Work • Quarterly In-Person Events Apply tot his job