QCI Specialist I

Astrana Health, Inc. • Cornwall, CT

12d • $26 - $35 • Hybrid

About The Position

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.

Requirements

• Must reside in Connecticut or the DMV Area (Washington D.C., Maryland, Virginia)
• Must be willing to travel up to 25% of the time
• 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

Nice To Haves

• Fluent in Spanish (preferred but not required)
• Bachelor’s degree or equivalent experience (preferred but not required)
• 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

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 to ensure accuracy and completeness for reporting purposes.
• Analyze provider performance data, identify trends, and deliver targeted education to drive improvements.
• Provide in-service training to primary care providers and office staff on quality metrics, incentive programs, and documentation integrity.
• Support project implementation aimed at enhancing service delivery, patient outcomes, and care experience.
• Guide practices through sustainable process improvements, including team building, leadership development, and operational redesign.
• Act as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standards.
• Conduct comprehensive training for PCPs and specialists on: Quality Measures, HEDIS and CMS Star Ratings, Performance-Based Incentive Programs, Data Accuracy and Documentation Standards.
• Perform additional duties and projects assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree