Hybrid Quality Improvement Specialist — HEDIS & CMS Stars

Astrana Health, Inc.; Monterey Park (CA); Hybrid; USD 34,000 - 41,000; Full time

Job summary

Astrana Health, Inc. seeks a QCI Specialist I to advance quality care across our Southern California IPAs. You will lead initiatives in HEDIS, CMS Star Ratings, and health plan quality metrics, reporting to the Supervisor of Quality Care Improvement.

You will partner with practices, review records, and guide teams through process improvements, with travel up to 25% and a hybrid in-office/remote schedule.

Qualifications

• Bachelor’s degree or equivalent experience.
• 3–5 years of healthcare experience, ideally IPA/MSO/Health Plan.
• Minimum of 1 year of HEDIS-related experience.
• Independent transportation and 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.

Responsibilities

• Partner with provider practices to improve performance on quality care measures.
• Collect, review, and validate medical records for reporting purposes.
• Analyze provider performance data and identify trends to drive improvements.
• Provide in-service training to PCPs and staff on quality metrics and documentation.
• Support project implementation to enhance service delivery and patient outcomes.
• Guide practices through sustainable process improvements and leadership development.
• Act as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standards.
• Train PCPs and specialists on Quality Measures, HEDIS, Star Ratings, incentives, and data accuracy.

Skills

Analytical skills

Communication skills

Presentation skills

Spanish/Chinese bilingual

Collaborative mindset

Education

Bachelor's degree or equivalent experience

Job description

Astrana Health, Inc. seeks a QCI Specialist I to advance quality care across our Southern California IPAs. You will lead initiatives in HEDIS, CMS Star Ratings, and health plan quality metrics, reporting to the Supervisor of Quality Care Improvement.

You will partner with practices, review records, and guide teams through process improvements, with travel up to 25% and a hybrid in-office/remote schedule.