Quality Care Improvement Specialist

This role is integral in supporting our mission to advance quality care across our network, particularly within the Southern California IPAs. Reporting to the Manager 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. Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team What You'll Do Build and maintain strong relationships with provider offices and clinic leadership. Conduct onsite and virtual provider outreach visits to review quality performance metrics, identify improvement opportunities, and retrieve relevant care gap closure data/records. Collaborate with assigned provider offices and health plans to improve documentation, coding accuracy, and care gap closure. Collect, review, and validate medical records to ensure accuracy and completeness for reporting purposes. Educate providers and office staff on quality measures, documentation standards, coding requirements, and best practices. Support monthly supplemental data submission, file preparation, and verification of compliant coding. Work with internal teams and vendors to validate, reconcile, and audit HEDIS records to ensure completeness and accuracy. Assist in developing QI initiatives such as outreach campaigns, provider education, and workflow optimization. Assist practices with workflow optimization, patient outreach strategies, and quality improvement interventions. Serve as a quality performance resource to assigned health plan partners, provider groups, clinics, and MSOs, providing and presenting HEDIS performance scorecards monthly. Monitor HEDIS progress dashboards and address data gaps prior to final submission. Prepare reports, scorecards, and presentations for leadership review. Obtain data needed for Primary Source Verification audits from health plans and vendors and ensure timely submission. Act as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standards. Conduct 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 Standards Perform additional duties and projects assigned. Qualifications Bachelor’s degree or equivalent experience 3–5 years of experience in healthcare, ideally in IPA/MSO/Health Plan environments Minimum of 1 year of HEDIS-related experience Independent transportation and ability to travel up to 25% as needed Strong knowledge of managed care and quality program standards Excellent analytical, communication, and presentation skills Demonstrates initiative, creativity, and a collaborative mindset You're great for the role if you are: Fluent in Spanish and/or Chinese (Mandarin/Cantonese) Familiar with practice management and financial operations Are adaptable, self-motivated, and eager to grow within a mission-driven organization Highly organized, detail-oriented, and capable of managing multiple priorities in a dynamic environment Experienced in outpatient clinical settings Environmental Job Requirements and Working Conditions The total pay range for this role is $24 - $34 per hour. This salary range represents our national target range for this role. This role follows a hybrid work structure where the expectation is to work on the field and at home on a weekly basis. This position requires up to 20% travel to provider offices in the San Diego area. Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on 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 based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] 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.