CalAIM QA Manager

Job not on LinkedIn

🔥 2 hours ago

🏄 California – Remote

🏄 California – Remote

💵 $102k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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Titanium Healthcare Inc.

WebsiteLinkedInAll Job Openings

201 - 500 employees

💼 Consulting

📦 Logistics

🏥 Healthcare

Consulting • Logistics • Healthcare

Titanium Healthcare Inc. is a healthcare organization dedicated to transforming and improving healthcare services for millions of Americans. The company provides an array of services, including primary care, care management, post-acute care, and telehealth, focusing on comprehensive and compassionate care. It operates multiple clinics in California and Washington, offering services such as enhanced care management and community supports, particularly for patients with complex needs. Titanium Healthcare emphasizes personalized patient care with longer appointment times and robust after-hours support, aiming to enhance the quality of life and health outcomes for Medicaid members and other patients. Moreover, they assist patients who face barriers like lack of access to medical care, food, housing, and transportation. They are also involved in community support through government-funded programs, ensuring that members receive necessary benefits at no additional cost.

📋 Description

• Manage completion of the internal audit schedule set by the Director, ensuring monthly and quarterly review targets are met on time across all assigned managed care plan contracts • Assign audit volume across the Quality Assurance Specialist team, monitor progress against the schedule, and reallocate workload as needed to stay on target • Notify the Director in advance when scheduled targets are at risk, with the cause and a proposed recovery plan • Conduct and oversee chart audits evaluating documentation accuracy, completeness, timeliness, and alignment with CalAIM and managed care plan requirements • Review completed audits for scoring accuracy and inter-rater consistency and resolve discrepancies before findings are released to the field • Lead recurring calibration sessions to keep scoring and interpretation consistent across all reviewers • Apply established audit tools, scoring rubrics, correction timelines, and escalation protocols consistently, and flag indicators that require revision to the Director • Maintain assigned audit tools and tracking documents in SharePoint, following established version control practices • Support preparation for managed care plan audits, including chart identification, documentation review, and assembly of requested files • Complete assigned corrective action steps within established timelines and provide supporting documentation of completion • Conduct follow-up review to verify that corrective actions have been implemented and are holding • Perform routine monitoring and spot checks to identify documentation risk in advance of external review • Maintain organized, audit-ready evidence files for completed internal audits • Escalate compliance risk, adverse findings, and potential contract issues to the Director promptly • Supervise, coach, and develop the Quality Assurance Specialist team, including onboarding, workload assignment, and day-to-day support • Conduct regular one-on-one check-ins and complete performance reviews in accordance with company timelines • Monitor auditor productivity and review quality, and address performance concerns promptly and constructively • Identify skill gaps within the team and communicate training needs to the Director and the Education team • Maintain quality assurance trackers and dashboards and ensure data accuracy at the source • Prepare monthly and quarterly audit reporting for the Director, including completion rates, scoring results, auditor productivity, and care coordinator performance • Summarize recurring findings and documentation trends and surface them to the Director for action • Communicate audit findings to supervisors and program managers and confirm that corrections are completed within required timelines • Deliver findings-based feedback and retraining to Lead Care Managers, Care Coordinators, and outreach staff • Share audit findings with the Education team so that training content and job aids can be updated.

🎯 Requirements

• Associate or bachelor’s degree in public health, social work, healthcare administration, human services, or another related field • Minimum 3+ years of experience in a Medi-Cal program environment, such as Enhanced Care Management, Community Supports, Health Homes, care coordination, or case management • Minimum 1+ year of experience supervising, leading, or formally mentoring staff • Demonstrated experience conducting chart audits or documentation reviews and interpreting health plan or regulatory documentation standards • Working knowledge of CalAIM program requirements and managed care plan documentation expectations • Experience with eClinicalWorks, Power BI, or Power Automate • Distraction-free home workspace with a secure internet connection

🏖️ Benefits

• 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 • Medical, Dental, & Vision Benefits: we cover up to 100% of your premium and 50% of your dependents depending on the plan • Prioritize your mental health with unlimited therapy sessions funded 100% by Titanium Healthcare • Flexible Spending, Health Savings & Dependent Care Accounts • Life/AD&D insurance funded 100% by Titanium Healthcare • Supplemental Short-Term Disability • Employee Assistance Programs • Protect your pet(s) with Pet Insurance • 401(k) plan