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Community Solutions for Children, Families, and Individuals • Gilroy, California, United States
Salary: $25 / hour
Role & seniority: Quality Assurance Administrator II; Regular, Full-Time, Non-Exempt, non-union; reports to Director of Quality Assurance and Compliance
Stack/tools: data analysis; report generation; QA dashboards; continuous quality improvement (CQI); Medi-Cal/EMR systems familiarity; project management; training/ facilitation
Oversee audits and site certifications; monitor compliance with regulatory, accreditation, and payor standards
Produce, verify, and synthesize program performance reports; maintain QA/O&E dashboards; provide monthly/quarterly/annual analyses
Develop, implement, and coach staff on CQI activities and documentation; lead internal audits and risk/compliance investigations
Must-have skills: data collection and analysis; effective reporting and communication of findings; data systems setup and maintenance; regulatory/compliance knowledge; project management; collaboration and group facilitation; customer service for monitoring services; valid California driver’s license
Nice-to-haves: experience with Medi-Cal billing/claims and Electronic Medical Records; experience handling large projects; familiarity with utilization management; familiarity with external Medi-Cal auditing, licensing, and accreditation
Location & work type: Gilroy, CA headquarters; on-site; full-time; requires automobile use for job duties; valid driver’s license and vehicle insurance; ability to travel as needed
POSITION TITLE: Quality Assurance Administrator II
JOB CLASSIFICATION: Regular, Full-Time, Non-Exempt, Non-Union, Benefitted
REPORTING RELATIONSHIP: Quality Assurance Program Supervisor
Since its founding as a teen drop-in center in 1972, Community Solutions (CS) has grown in both depth and breadth of services in response to the growing and changing needs in the community. As one of the most comprehensive nonprofit human services agencies in Santa Clara County and the surrounding areas, CS provides prevention, intervention, treatment, and residential services to more than 6,400 clients annually, helping them overcome the challenges posed by mental health issues, substance abuse, trauma, severe family dysfunction, sexual and domestic violence, and human trafficking.
Under the general direction of the Director of Quality Assurance and Compliance, the Quality Assurance Administrator II provides comprehensive data analysis and reports generation in addition to monitoring and evaluating documentation standards, service provision and other projects and processes to support behavioral health programs and other agency operations. Responsibilities include monitoring the integration of best practices and cost-effective services; assists with creating, facilitating, and training procedures that guide staff in compliance with regulatory, accreditation and payor standards; serving as a representative for Community Solutions on County committees; and supports Operations division with other needs, as necessary.
Education and Experience: A.A. Degree or equivalent and two (2) years of related office experience majority must be in behavioral health, human services, or similar setting. Experience handling large projects using data collection, tracking processes, generating reports, and systems management. Experience with applicable software to gather statistical data, Medi-Cal Billing, and Electronic Medical Records systems is highly desirable.
Knowledge: Demonstrated ability to input data using systems and practices and handle large amounts of data collection. Produce useful reports and effectively communicate analysis of data. Demonstrated ability to input data, develop data collection systems and practices, and synthetize information into useful reports. Utilize continuous improvement systems. Group facilitation skills and the demonstrated ability to work collaboratively with others. Customer service skills to support the monitoring of treatment services; maintenance of clinical and fiscal records and systems; Understanding of the interdependency and competing demands of organizational support departments, clinical and managerial staff, and external customers. Ability to adapt to changing regulatory, accreditation or other agency requirements. Knowledge of project management and computer proficiency required.
Special Requirements: Must be able to receive a criminal record clearance as required by specific programs, funding requirements and licensing regulations. Requires an automobile to perform routine job duties and requires the willingness and ability to transport clients in your own vehicle.
License: A valid CA driver’s license or ability to obtain CDL, current car insurance and a good driving record as documented by a DMV report and consistent with the Agency’s liability insurance requirements is required.
Takes a lead role in overseeing audits and site certifications. Produces and verifies the accuracy of reports. Synthesizes and analyzes program performance indicators developed by the QA and Outcomes & Evaluation (O&E) teams. Facilitates their consistent use across all assigned programs. Provides training to others to support the use of data in managing, reporting, and analysis skills of others. Supports the current Quality Improvement dashboards by creating monthly director level reports and analysis of program audit results. Creates, implements, and monitors Continuous Quality Improvement (CQI) activities. Partners with program management to provide coaching and training related to documentation of CQI activities. Participates in CQI workgroups and project teams as assigned. Implement agency plan for external Medi-Cal auditing, including Agency licensing and accreditation. Implement and leads project and change activities and internal audit procedures. Investigate, analyze, and report compliance related issues including suspected fraud, breach of protected health information, etc. Implement service verification processes to identify individuals or entities engaged in potential fraud and abuse. Conducts service verification calls with clients to verify services occurred. Receives, tracks, and monitors resolution of consumer/family complaints regarding services. Reviews reports and monitors account transactions that are potentially fraudulent. Support agency initiates by tracking and analyzing individual and program follow through in a project plan and compliance with plan of corrections. Implements and development of utilization management protocols and review systems. Monitors compliance with established procedures for internal audits of Medi-Cal services and clinical programs; provides analysis of summary reports; provides feedback to support CQI of audit processes. Obtain, investigate, analyze, and track adverse incidents; ensure reports are distributed properly and follow up action is taken to resolution. Investigate, analyze, and report compliance related issues including suspected fraud, breach of protected health information, etc. Presents findings of service verification analyses to Employee Relationship and Division Directors to determine in next steps. Presents information that supports whether employee behaviors reflect performance or conduct issues. Generate monthly, quarterly, and annual reports with analysis and recommendations; provide reports as needed to management. Responsible for the development and implementation of protocols, systems and identifying training needs to assist staff to comply with contractual, regulatory, accreditation and excellent practice and standards, while monitoring compliance.
Develops job aids: using sequence ordered details and screenshots, publishes overviews of processes used at the program, division, and agency level. Participates and occasionally leads agency projects to support continued quality improvement throughout the agency. Attends and participates in Agency and team meetings as required. Attends and participates in County meetings and workgroups as necessary. Successfully completes all training within the required time frame. Utilizes personal or agency vehicles for company business, as needed. Other QA and Compliance duties as assigned.
Community Solutions is deeply committed to diversity, equity, and inclusion. We are a team of dedicated professionals with backgrounds as diverse as the impact we achieve. We are committed to diversity in our workforce and equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. We encourage candidates from all backgrounds to apply.
100% of premiums paid by employer for full-time employees and eligible dependent children 403(b) Retirement Plan with 5% employer match 3-weeks paid vacation to start 13 paid holidays; 96 sick hours per year (inclusive of self-care/mental health days) Longevity bonuses Generous family medical leave for eligible employees Student Loan Forgiveness Program Staff learning and development and robust in-house training opportunities Employee-led Diversity, Equity, and Inclusion Resource Group
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to both sit and stand for extended periods, talk and hear, and use office equipment; occasional need to lift and move objects up to 25lbs.
Work Environment and Location: This position is located at our Gilroy Headquarters office.
Must be able to meet and receive a criminal records clearance as required by specific programs, licensing regulations and Community Solutions practices.
License: Possess a valid California driver’s license, current car insurance and a good driving record as documented by a DMV report and consistent with the Agency’s liability insurance requirements. Requires an automobile to perform routine job duties.
COVID-19 Vaccination: Please note that Community Solutions has adopted a COVID-19 vaccination policy to safeguard the health and well-being of our employees and clients. As a condition of employment, Community Solutions employees are required to be fully vaccinated for COVID-19, unless a reasonable accommodation is approved or as otherwise required by law.
Note: This job description outlines primary duties, qualifications, and job scope, but is not intended to be a comprehensive description of job responsibilities. We expect each employee to offer their services wherever and whenever necessary to ensure the success of our endeavors.
All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills aptitudes and abilities to perform each duty proficiently.
Candidates for this position must be legally authorized to work directly as an employee for any employer in the United States without visa sponsorship.