QCI Specialist I
About The Position
The QCI Specialist I supports quality care initiatives across the organization’s network, particularly within Southern California IPAs. Reporting to the Supervisor of Quality Care Improvement, this role 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 position partners with provider practices on practice transformation and population health management; reviews medical records and provider performance data; and provides training and education to improve quality measures, documentation, and care delivery. The role 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. Travel of up to 25% is required to provider offices in the San Gabriel Valley area. Compensation is $25.00–$30.00 per hour, with actual pay determined by geographic location, experience, and other job-related factors.
Requirements
- Bachelor’s degree or equivalent experience.
- 3–5 years of healthcare experience; experience in an IPA, MSO, or health plan environment is ideal.
- 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.
- Demonstrated 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 quality care measure performance, 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.
- Train primary care providers and office staff on quality metrics, incentive programs, and documentation integrity.
- Support projects intended to improve 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, data accuracy, and documentation standards.
- Perform additional duties and projects as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
