Titanium Healthcare Inc. logo
Titanium Healthcare Inc.

The Heart & Science of Healthcare.

CalAIM Quality Assurance Specialist

QA EngineerQA EngineerFull TimeRemoteMid LevelTeam 201-500H1B No SponsorCompany SiteLinkedIn

Location

California

Posted

6 days ago

Salary

$70K - $75K / year

Seniority

Mid Level

Bachelor Degree2 yrs expEnglish

Job Description

• Conduct routine chart audits to evaluate documentation accuracy, completeness, and alignment with CalAIM program and Managed Care Plan requirements • Review member encounters, care management documentation, outreach efforts, and service plans to ensure services are properly documented • Identify documentation gaps, workflow challenges, or compliance risks and communicate findings to leadership • Track audit findings and monitor trends in documentation quality across teams and regions to inform quality improvement efforts • Monitor compliance with CalAIM program requirements and Managed Care Plan guidelines • Support internal reviews and external audits by preparing documentation and assisting leadership with audit preparation • Support the collection and review of audit results and quality metrics

Job Requirements

  • Associate or bachelor’s degree in public health, social work, healthcare administration, human services, or another related field
  • Minimum 2+ years of experience working in a Medi-Cal program environment, such as Enhanced Care Management, Community Supports, Health Homes, care coordination, or case management
  • Experience reviewing or documenting member records within an electronic health record system, including encounters, case notes, care plans, or service documentation
  • Strong understanding of documentation standards and program compliance requirements, with experience reviewing member records and identifying documentation or regulatory gaps
  • Ability to interpret program requirements, policies, and health plan guidance and apply them during documentation review
  • Strong attention to detail with the ability to review documentation for accuracy, completeness, and compliance with program standards
  • Excellent written and verbal communication skills, with the ability to clearly document audit findings and communicate feedback to staff and leadership
  • Analytical thinking and problem-solving skills to identify documentation trends, workflow gaps, and opportunities for improvement
  • Proficiency in Microsoft Office applications including Excel, Teams, and SharePoint for tracking, reporting, and collaboration
  • Ability to communicate clearly and professionally through virtual meeting platforms and written communication tools

Benefits

  • Medical, Dental, & Vision Benefits: we cover up to 100% of your premium and 50% of your dependents depending on the plan
  • Paid Time Off: 12 holidays and up to 15 days of accrued PTO to rest and recharge plus additional time for sick, jury duty, bereavement, reproductive loss, and therapy
  • Work Life Balance: enjoy flexibility to maximize your well-being and success with our hybrid work model
  • Prioritize your mental health with unlimited therapy sessions funded 100% by Titanium Healthcare
  • 401(k) plan
  • Employee Assistance Programs
  • Protect your pet(s) with Pet Insurance
  • Life/AD&D insurance funded 100% by Titanium Healthcare
  • Flexible Spending, Health Savings & Dependent Care Accounts

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