Quality Care Improvement Specialist

Astrana Health, Inc.•Orange, CA

5d•$24 - $34•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 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.

Requirements

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

Nice To Haves

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

Responsibilities

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: Quality Measures, HEDIS and CMS Star Ratings, Performance-Based Incentive Programs, Data Accuracy and Documentation Standards.
Perform additional duties and projects assigned.