Member Coordinator Quality Assurance Specialist presso Pacific Health Group

Description

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 profiles
• Complete and timely disenrollment cycle documentation
• Consistent achievement of ECM QA metric thresholds

Requirements

• 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

Benefits

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.