Clinical Quality Specialist
About The Position
At Altais, we’re on a mission to improve the healthcare experience for everyone—starting with the people who deliver it. We believe physicians should spend more time with patients and less time on administrative tasks. Through smarter technology, purpose-built tools, and a team-based model of care, we help doctors do what they do best: care for people. Altais includes a network of physician-led organizations across California, including Brown & Toland Physicians, Altais Medical Group Riverside, and Family Care Specialists. Together, we’re building a stronger, more connected healthcare system. About the Role Are you looking to join a fast-growing, dynamic team? We’re a collaborative, purpose-driven group that’s passionate about transforming healthcare from the inside out. At Altais, we support one another, adapt quickly, and work with integrity as we build a better experience for physicians and their patients. The Clinical Quality Specialist supports quality improvement efforts by focusing on HEDIS, CMS Star Ratings, P4P, and patient experience measures. This role involves working directly with health plans and provider practices to close care gaps, conduct medical record reviews, and create educational materials for members and providers.
Requirements
- Minimum 3 years of prior relevant experience in managed care quality improvement, care management or clinical program management in a clinical/healthcare environment
- Working knowledge of HEDIS, CAHPS, HOS, CMS Medicare Star Ratings, P4P programs, CMS quality withhold, Managed Care Accountability Set (MCAS) and NCQA Quality Improvement standards
Responsibilities
- Conduct medical record reviews to identify and close HEDIS/Stars and quality care gaps.
- Prepare and deliver provider-level scorecards and reports based on quality measure performance.
- Meet regularly with provider offices to review care gap data, address documentation needs, and share improvement strategies.
- Collaborate with internal teams and providers to implement interventions that support HEDIS, P4P, CMS Stars, and patient experience goals.
- Develop, customize, and distribute educational collateral and reminders for members and providers (flyers, letters, tip sheets).
- Lead or support member outreach campaigns (calls, letters, emails) to encourage screenings, follow-ups, or other preventive services.
- Track outreach results and follow up as needed to support care gap closure.
- Monitor data for accuracy and identify discrepancies in claims or documentation affecting quality performance.
- Stay up to date on HEDIS, P4P, and CMS/Star specifications; communicate changes to relevant stakeholders.
- Support audit preparation by validating data and ensuring appropriate documentation is collected.
- Assist with vendor relationships, outreach campaigns and bulk ordering workflows for screenings and preventive services.
- Maintain accurate tracking of interventions, outreach, and follow-ups to support reporting needs.
Benefits
- Excellent medical, vision, and dental coverage
- 401k savings plan with a company match
- Flexible time off and 9 Paid Holidays
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
