QCI Specialist I

This role is integral in supporting our mission to advance quality care across our network, particularly within the Southern California IPAs. Reporting to the Supervisor of Quality Care Improvement, the Specialist will serve as a key liaison to lead and coordinate initiatives that drive performance in HEDIS, CMS Star Ratings (Part C & D), and overall health plan quality metrics.What You'll DoPartner with provider practices to improve performance on quality care measures, focusing on practice transformation and population health managementCollect, review, and validate medical records to ensure accuracy and completeness for reporting purposesAnalyze provider performance data, identify trends, and deliver targeted education to drive improvementsProvide in-service training to primary care providers and office staff on quality metrics, incentive programs, and documentation integritySupport project implementation aimed at enhancing service delivery, patient outcomes, and care experienceGuide practices through sustainable process improvements, including team building, leadership development, and operational redesignAct as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standardsConduct comprehensive training for PCPs and specialists on:1. Quality Measures 2. HEDIS and CMS Star Ratings 3. Performance-Based Incentive Programs 4. Data Accuracy and Documentation StandardsPerform additional duties and projects as assignedQualificationsBachelor’s degree or equivalent experience3–5 years of experience in healthcare, ideally in IPA/MSO/Health Plan environmentsMinimum of 1 year of HEDIS-related experienceIndependent transportation and ability to travel up to 25% as neededStrong knowledge of managed care and quality program standardsExcellent analytical, communication, and presentation skillsDemonstrates initiative, creativity, and a collaborative mindsetYou're great for the role if you are:Fluent in Spanish and/or Chinese (Mandarin/Cantonese)Familiar with practice management and financial operationsAre adaptable, self-motivated, and eager to grow within a mission-driven organizationHighly organized, detail-oriented, and capable of managing multiple priorities in a dynamic environmentExperienced in outpatient clinical settings Environmental Job Requirements and Working ConditionsOur organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The home office is located at 1600 Corporate Center Drive, Monterey Park, CA 91754.This position requires up to 25% travel to provider offices in the San Gabriel Valley area.The total compensation target pay range for this role is between $25.00 - $30.00 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.