CalAIM QA Manager

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🕒 vor 2 Tagen

🏄 California – Remote

🏄 California – Remote

💵 $102.000 / Jahr

⏰ Vollzeit

🟡 Mittelstufe

🟠 Senior

🔧 QA-Ingenieur (Qualitätssicherung)

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Titanium Healthcare Inc.

WebsiteLinkedInAlle Stellen

201 - 500 Mitarbeiter

💼 Beratung

📦 Logistik

🏥 Gesundheitswesen

Consulting • Logistics • Healthcare

Titanium Healthcare Inc. ist eine Gesundheitsorganisation, die sich der Transformation und Verbesserung von Gesundheitsdienstleistungen für Millionen von Amerikanern widmet. Das Unternehmen bietet eine Reihe von Dienstleistungen an, darunter Primärversorgung, Pflegemanagement, Nachsorge und Telemedizin, mit einem Schwerpunkt auf umfassender und mitfühlender Pflege. Es betreibt mehrere Kliniken in Kalifornien und Washington, die Dienstleistungen wie erweitertes Fallmanagement und Gemeinschaftsunterstützung anbieten, insbesondere für Patienten mit komplexen Bedürfnissen. Titanium Healthcare legt Wert auf eine personalisierte Patientenbetreuung mit längeren Terminzeiten und umfassender Unterstützung außerhalb der regulären Zeiten, um die Lebensqualität und Gesundheitsergebnisse für Medicaid-Mitglieder und andere Patienten zu verbessern. Außerdem unterstützt das Unternehmen Patienten, die vor Hürden wie mangelndem Zugang zu medizinischer Versorgung, Nahrung, Wohnung und Transport stehen. Sie engagieren sich auch in der Gemeinschaftsunterstützung durch staatlich geförderte Programme und stellen sicher, dass Mitglieder die erforderlichen Leistungen ohne zusätzliche Kosten erhalten.

Beschreibung

• 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.

🎯 Anforderungen

• 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

🏖️ Vorteile

• 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