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Pacific Health Group · 1 month ago

Member Coordinator Quality Assurance Specialist

United States

Full-time

Remote

Mid Level

$30/hr - $33/hr

Pacific Health Group is transforming healthcare by connecting people to the care and community resources they deserve. The Member Coordinator Quality Assurance Specialist ensures quality and compliance across operations, serving as an internal auditor and process-improvement lead.

Health CareHospitalMedicalTelehealth

Responsibilities

Ensures quality, compliance, workflow accuracy, and performance excellence across both Enhanced Care Management (ECM) and Member Coordination operations

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

Strengthens operational integrity, ensures regulatory compliance, and builds a culture of accountability and continuous improvement within the newly developed QA unit

Qualification

Quality AssuranceWorkflow AnalysisRegulatory ComplianceProcess ImprovementDocumentation AccuracyOutreach Standards ComplianceMember VerificationAttention to DetailContinuous ImprovementAccountability

Required

Ensures quality, compliance, workflow accuracy, and performance excellence across both Enhanced Care Management (ECM) and Member Coordination operations

Strengthens operational integrity, ensures regulatory compliance, and builds a culture of accountability and continuous improvement within the newly developed QA unit

Achieves 95%+ documentation accuracy across all workflows

Maintains 100% compliance with required outreach standards

Ensures accurate verification across all member profiles

Completes and timely disenrollment cycle documentation

Consistently achieves ECM QA metric thresholds