Quality Improvement (QI) Coordinator

Guidant MSO; Murrieta (CA); On-site; USD 65,000 - 85,000; Full time

Job summary

Guidant MSO is seeking a Quality Improvement Coordinator to support HEDIS/Stars, gap closure, medical record abstraction, and data tracking across Medicare Advantage, Medi-Cal, and commercial lines.

You will work with providers and health-plan teams to ensure accurate documentation and timely reporting, while driving quality initiatives and educational materials for field staff.

Qualifications

• Minimum 2 years of healthcare experience, with 1 year in Quality Improvement or HEDIS/Stars.
• Familiarity with HEDIS/Stars measure specs and managed-care quality programs.
• Strong Excel skills (pivot tables, VLOOKUP/XLOOKUP) and data cleanup.
• Excellent attention to detail and ability to manage multiple priorities.
• Effective communication and collaboration with providers and teams.
• Ability to learn and apply CPT, ICD-10, HCPCS coding basics.

Responsibilities

• Monitor HEDIS, Medicare Stars, MCAS, and health-plan performance at MSO, provider-group, and provider levels.
• Generate, reconcile, and work patient-level gaps-in-care reports.
• Coordinate member outreach and gap-closure initiatives for preventive screenings and chronic-condition management.
• Review medical records and abstract information per HEDIS specifications and guidelines.
• Obtain documentation from provider offices to support gap closure and audits.
• Prepare and submit supplemental data and gap-closure evidence and track acceptance or rejection.
• Reconcile health-plan reports against internal data and provider documentation to identify discrepancies.
• Maintain quality dashboards, trackers, provider scorecards, and centralized QI tools.
• Collaborate with providers on quality measures, coding/documentation, and gap lists.
• Assist with provider education and development of HEDIS/Stars tip sheets and training materials.
• Support health-plan quality audits and NCQA requests.

Skills

Healthcare experience

Quality Improvement

HEDIS/Stars

Population health

Care coordination

Excel

Pivot tables

VLOOKUP/XLOOKUP

Data analysis

Communication

Tools

Power BI

Epic

eClinicalWorks

NextGen

Job description

Guidant MSO | MSO Operations – Quality Improvement

Guidant MSO is growing, and we’re looking for a Quality Improvement Coordinator to join our Quality Improvement team.

This is a hands-on role supporting quality programs across our Medicare Advantage, Medi-Cal, and commercial lines of business . The QI Coordinator will work closely with contracted providers, health plan quality teams, and internal departments to support HEDIS/Stars performance, gap-in-care closure, medical record retrieval and abstraction, supplemental data submission, provider education, and quality reporting.

At Guidant, Quality Improvement is about more than simply working an outreach list. We’re looking for someone who is curious, detail-oriented, and willing to investigate why a gap exists, what evidence is needed, and what action will truly resolve it.

What You’ll Do

In this role, you will help:

• Monitor HEDIS, Medicare Stars, MCAS, and health-plan P4P performance at the MSO, provider-group, and individual-provider levels.
• Generate, reconcile, and work patient-level gaps-in-care reports.
• Coordinate member outreach and gap-closure initiatives for preventive screenings, chronic-condition management, medication adherence, annual wellness visits, and other quality measures.
• Review medical records and abstract information according to HEDIS specifications and health-plan guidelines.
• Obtain documentation from provider offices to support gap closure, audits, and quality initiatives.
• Prepare and submit supplemental data and gap-closure evidence and track acceptance or rejection.
• Reconcile health-plan reports against internal data, provider documentation, and supplemental submissions to identify discrepancies and additional opportunities.
• Maintain quality dashboards, measure trackers, provider scorecards, and centralized QI tracking tools.
• Collaborate directly with provider offices regarding quality measures, coding/documentation requirements, gap lists, and quality initiatives.
• Assist with provider education and development of HEDIS/Stars tip sheets and training materials.
• Support health-plan quality audits, NCQA-related requests, corrective-action documentation, and measurement-year readiness.
• Participate in health-plan quality meetings and track action items through completion.
• Identify trends, barriers, and opportunities for improvement and communicate recommendations to QI leadership.

What We’re Looking For

We’re looking for someone with:

• At least 2 years of healthcare experience, including at least 1 year in Quality Improvement, HEDIS/Stars, population health, or care coordination within a managed-care, MSO, IPA, medical-group, or health-plan environment.
• Working knowledge of or demonstrated ability to learn HEDIS/Stars measure specifications and managed-care quality programs.
• Familiarity with medical terminology and quality-related CPT, CPT II, ICD-10, and HCPCS coding.
• Strong Microsoft Excel skills, including pivot tables, VLOOKUP/XLOOKUP, data cleanup, and working accurately with larger datasets.
• Strong analytical and problem-solving skills.
• Excellent attention to detail and data accuracy.
• Ability to manage multiple priorities, deadlines, reports, and follow-up items.
• Strong communication skills and the ability to build collaborative relationships with providers, health plans, and internal teams.
• Initiative, accountability, and the ability to follow an issue through to resolution.

Preferred Experience

Experience with any of the following is a plus:

• Medicare Advantage Stars, Medi-Cal MCAS, and/or commercial P4P programs
• NCQA standards
• Medical-record review and abstraction
• MA, LVN, CNA, or other clinical background
• EZ-CAP and health-plan quality/provider portals
• Power BI or similar reporting tools
• EHR systems such as Epic, eClinicalWorks, or NextGen
• HIE platforms
• CPC or other coding/quality certification
• Bilingual English/Spanish or another language relevant to our member population