Health Plan Quality Assurance & Training Specialist

Health Plan Quality Assurance & Training Specialist Western Health Advantage Location:

• Sacramento, CA (Hybrid) Salary: $28.00 - $36.00 per hour Our purpose is strong, our impact is lasting, join us on the journey Western Health Advantage  Western Health Advantage is seeking a Health Plan Quality Assurance & Training Specialist to support compliance, quality improvement, and staff development within our Appeals & Grievances (A&G), Utilization Management (UM), and Clinical Resources teams.


• In this role, you will conduct audits of clinical and non-clinical cases to ensure compliance with DMHC, NCQA, HICE, and organizational requirements.
• You will analyze audit results, identify trends and opportunities for improvement, maintain audit documentation and reporting, support delegation oversight activities, and assist with regulatory readiness efforts.
• Key Responsibilities Conduct quality audits of Appeals & Grievance...