QCI Specialist

Astrana Health; California (MO); Hybrid; USD 31,684 - 45,460; Full time

Job summary

A healthcare organization is seeking a Quality Care Improvement Specialist to enhance quality care across its network in Southern California. The ideal candidate has a Bachelor’s degree, strong analytical skills, and experience in managed care. The role involves partnering with provider offices, analyzing data, and conducting training sessions. Knowledge of HEDIS and the ability to travel 25% are key requirements. This is a full-time position with a hybrid work environment, offering competitive hourly pay.

Qualifications

• 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.
• Demonstrates initiative and creativity.

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 deliver targeted education.
• Conduct training for PCPs and specialists on quality metrics.

Skills

Fluent in Spanish

Fluent in Chinese (Mandarin/Cantonese)

Excellent analytical skills

Communication skills

Presentation skills

Strong knowledge of managed care

Collaborative mindset

Education

Bachelor’s degree or equivalent experience

Job description

QCI Specialist

Astrana Health

Department: Quality – Quality Care Improvement

Location: 600 City Parkway West 10th Floor, Orange, CA 92868

Compensation: $23.00 - $33.00 / hour

Overview

The Quality Care Improvement Specialist 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.

Values

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You’ll Do

• 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.

Qualifications

• 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

You're great for the role if you are:

• Fluent in Spanish and/or Chinese (Mandarin/Cantonese)
• Familiar with practice management and financial operations
• 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

Environmental Job Requirements and Working Conditions

• The total pay range for this role is $23 - $33 per hour. This salary range represents our national target range for this role.
• This role follows a hybrid work structure where the expectation is to work on the field and at home on a weekly basis. This position requires up to 25% travel to provider offices in the Southern California area. The home office is located at 600 City Parkway West 10th Floor, Orange, CA 92868.

Equal Opportunity Statement

Astrana Health is proud to be an Equal Employment Opportunity and affirmative action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance applying for open positions due to a disability, please email us at [e-mail] to request an accommodation.

Additional Information

The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Seniority level

Mid‑Senior level

Employment type

Full‑time

Job function

Other

Industries

Hospitals and Health Care