Astrana Health

Technology-enabled platform delivering value-based care

QCI Specialist 1

Medical, Clinical & VeterinaryUpdated on Nov 13

Full-timeMonterey Park, CA, USA$25 - $30 /hr

About the Job

Requirements

A bachelor's degree or equivalent experience is required.
Three to five years of experience in healthcare, ideally in IPA, MSO, or health plan environments, is required.
At least one year of HEDIS-related experience is required.
Independent transportation and the ability to travel up to 25% as needed are required.
Strong knowledge of managed care and quality program standards is required.
Strong analytical, communication, and presentation skills are required.

Responsibilities

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 primary care providers and specialists on quality measures; HEDIS and CMS Star Ratings; performance-based incentive programs; and data accuracy and documentation standards.
Perform additional duties and projects as assigned.

Desired Qualifications

Fluency in Spanish and/or Chinese (Mandarin or Cantonese).
Familiarity with practice management and financial operations.
Adaptability, self-motivation, and eagerness to grow within a mission-driven organization.
Strong organization, attention to detail, and ability to manage multiple priorities in a dynamic environment.
Experience in outpatient clinical settings.

This role 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.

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:
- 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 as assigned

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
Are 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

About the Company

Astrana Health

Technology-enabled platform delivering value-based care

Astrana Health runs a physician-focused, technology-enabled care platform that supports providers in delivering proactive, preventive, value-based care. Its end-to-end system coordinates care across affiliated networks, a management services organization, and primary, specialty, and ancillary clinics to help more than 20,000 providers and over 1.6 million Americans in value-based arrangements. How it works: the proprietary platform connects clinicians, patients, and care settings, enabling proactive care planning, care coordination, and efficient delivery of services in primary and specialty care. The company differentiates itself by combining a large provider network, an MSO, and clinics with a single tech platform to scale value-based care and improve patient experiences and outcomes rather than relying on fragmented, fee-for-service models. Its goal is to create a healthcare system that delivers better care, better experiences, and better outcomes for all.

Company size: 501-1,000
Company stage: Not listed
Total funding: Not listed
Headquarters: Alhambra, CA
Founded: Not listed

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