Quality Care Improvement Specialist II

Astrana Health; Rhode Island; Hybride; USD 44 000 - 54 000; Plein temps

Résumé du poste

Astrana Health is seeking a Quality Care Improvement Specialist II to develop, implement, and optimize quality initiatives across practice networks. You will partner with practices to redesign workflows, supervise care teams, and advance population health and performance programs.

The role requires 3–5 years in healthcare, HEDIS experience, and strong managed care knowledge. Expect hybrid work with field travel to Rhode Island locations and collaboration with the Quality - Operations department.

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.
• Strong knowledge of managed care and quality program standards.

Responsabilités

• Partner with provider practices onsite and remotely 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.
• Lead, mentor, and guide the Quality Care Improvement Specialist team to achieve performance and quality goals.
• Act as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standards.
• Develop and execute intervention work plans to drive practice and improve quality measures and transformation.
• Develop and implement workflow design and redesign, including EHR optimization, clinical documentation, billing practices, assessments, financial analyses, and financial performance improvement and reporting.
• Conduct comprehensive training for PCPs and specialists on Quality Measures, HEDIS and CMS Star Ratings, Performance-Based Incentive Programs, and Data Accuracy and Documentation Standards.

Connaissances

Healthcare analytics

HEDIS knowledge

Communication skills

Training delivery

Project coordination

Formation

Bachelor’s degree or equivalent experience

Outils

EHR systems

Description du poste

Location: 1301 Atwood Avenue, Suite 206N, Johnston, RI 02919

Compensation: $32.00 - $39.00 / hour

Department: Quality - Operations

Description

The Quality Care Improvement Specialist II develops, recommends, and implements interventions at the practice and membership level to improve quality and operational efficiency. You will collaborate with practices to facilitate redesign efforts, support care teams, introduce population health management, and support achievement toward improved financial and clinical outcomes. This role is integral to advancing quality care across our network.

What You'll Do

• Partner with provider practices onsite and remotely 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
• Lead, mentor, and guide the Quality Care Improvement Specialist team to achieve performance and quality goals
• Act as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standards
• Develop and execute a set of intervention work plans to drive practice and improve quality measures and transformation
• Develop and implement workflow design and redesign, including electronic health record (EHR) optimization, clinical documentation, billing practices, assessments, financial analyses, and financial performance improvement and reporting
• Conduct comprehensive training for PCPs and specialists on
  • Quality Measures
  • HEDIS and CMS Star Ratings
  • Performance-Based Incentive Programs
  • Data Accuracy and Documentation Standards
• Other duties may be 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
• 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 Portuguese (preferred but not required)
• 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

• 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 Rhode Island area. The home office is located at 1301 Atwood Avenue, Suite 206N, Johnston, RI 02919.
• The target pay range for this role is between $32.00 - $39.00 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job‑related factors.

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 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 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.