The use of quality assurance (QA) processes in highway infrastructure is critical to ensure durable, safe, and economical transportation operations. These processes ensure the desired level of quality is maintained throughout manufacturing. Precast and pre-stressed concrete elements are commonly used in highway construction projects, including many bridge elements and drainage components. Owing to their widespread usage, it is necessary to have a comprehensive QA process that includes plant certification, manufacturer’s process and quality control, and agency inspection and acceptance testing. In many cases, one manufacturing plant will serve a region, fabricating a variety of elements for many state departments of transportation (DOTs). Since different state DOTs may have different QA processes in their specifications, the plants need to adjust the fabrication process with respect to these criteria, which results in higher expenses and lower productivity. Furthermore, each agency will need to provide inspection and acceptance testing resources at a fabricator’s location. This study reviews and evaluates the current QA processes for precast and pre-stressed concrete elements used in highway construction in the New England region. Based on a review of current practices, a set of unified QA process recommendations have been developed. This will result in significant financial savings by reducing the number of QA inspectors if the manufacturers for different construction projects around the region follow a unified procedure for maintaining and evaluating the quality of their products. Recommendations for plant/producer prequalification, pre-placement, during placement, and post-placement quality control and agency inspection practices have been developed and are presented.