QCI Specialist

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

Job summary

A healthcare organization is seeking a QCI Specialist to enhance quality care across its network. This role focuses on improving health plan metrics and collaborating with various healthcare providers. The ideal candidate will possess a Bachelor's degree and have 3–5 years of healthcare experience, including HEDIS expertise. Strong analytical and communication skills are essential, as well as the ability to travel up to 25% in Southern California. This position offers a hybrid work model with competitive hourly compensation.

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.

Responsibilities

• Serve as a quality performance resource to assigned health plan partners.
• Collaborate with assigned health plans and/or provider offices.
• Analyze provider performance data, identify trends, and deliver targeted education.

Skills

Analytical skills

Communication skills

Presentation skills

Knowledge of managed care

Collaboration

Education

Bachelor’s degree or equivalent experience

Job description

QCI Specialist

Company: Astrana Health

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

Compensation: $23.00 - $33.00 / hour

Department: Quality - Quality Care Improvement

Seniority level: Mid‑Senior level

Employment type: Full‑time

Job function: Other

Industries: Hospitals and Health Care

Description

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.

Our Values

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

What You'll Do

• Serve as a quality performance resource to assigned health plan partners, provider groups, clinics, and MSOs, providing and presenting HEDIS performance scorecards monthly.
• Collaborate with assigned health plans and/or provider offices to improve documentation, coding accuracy, and care gap closure.
• 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.
• 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.
• 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.
• Provide in‑service training to primary care providers and office staff on quality metrics, incentive programs, and documentation integrity.
• Act as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standards.
• Conduct comprehensive training for PCPs and specialists on:
  1. Quality Measures
  2. HEDIS and CMS Star Ratings
  3. Performance‑Based Incentive Programs
  4. 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

Additional Desired

• 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 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 Employment 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 in applying for open positions due to a disability, please email [e-mail] to request an accommodation.