QCI Specialist I

Astrana Health, Inc. • Monterey Park, CA

2d • $25 - $30 • Hybrid

About The Position

The QCI Specialist I supports Astrana Health’s mission to advance quality care across its network, particularly within Southern California IPAs. Reporting to the Supervisor of Quality Care Improvement, the Specialist serves as a liaison who leads and coordinates initiatives to improve HEDIS performance, CMS Star Ratings (Part C and D), and overall health plan quality metrics. The role partners with provider practices on practice transformation and population health management; reviews and validates medical records; analyzes performance data; provides education and training; and supports projects that improve service delivery, patient outcomes, and care experience. The Specialist also guides practices through sustainable process improvements and serves as a subject matter expert on relevant quality, regulatory, and health plan standards.

The position follows a hybrid work structure, with work performed both in the office and at home each week. The home office is in Monterey Park, California, and the role requires up to 25% travel to provider offices in the San Gabriel Valley area. Compensation is $25.00–$30.00 per hour, with actual compensation determined by geographic location, experience, and other job-related factors.

Requirements

• Bachelor’s degree or equivalent experience.
• 3–5 years of experience in healthcare; experience in IPA, MSO, or health plan environments is preferred.
• At least 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.
• Initiative, creativity, and a collaborative mindset.

Nice To Haves

• Fluency in Spanish and/or Chinese (Mandarin or Cantonese).
• Familiarity with practice management and financial operations.
• Adaptability, self-motivation, and eagerness to grow within a mission-driven organization.
• Strong organization and attention to detail, with the ability to manage multiple priorities in a dynamic environment.
• Experience in outpatient clinical settings.

Responsibilities

• Partner with provider practices to improve performance on quality care measures, focusing on practice transformation and population health management.
• Collect, review, and validate medical records for accurate and complete reporting.
• Analyze provider performance data, identify trends, and provide targeted education to drive improvement.
• Provide in-service training to primary care providers and office staff on quality metrics, incentive programs, and documentation integrity.
• Support projects intended to enhance service delivery, patient outcomes, and care experience.
• Guide practices through sustainable process improvements, including team building, leadership development, and operational redesign.
• Serve as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standards.
• Train primary care providers and specialists on quality measures, HEDIS and CMS Star Ratings, performance-based incentive programs, and data accuracy and documentation standards.
• Perform additional duties and projects as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level