QCI Specialist I

Department: Quality - Quality Care Improvement

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

Compensation: $25.71 - $32.99 / hour

Description

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.

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
• Conduct targeted member outreach to support strategic initiatives and campaigns aimed at improving performance metrics for health plans and provider offices
• Collaborate with assigned health plans and/or provider offices to improve documentation, coding accuracy, and care gap closure
• Collect, review, validate and attest 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
• Lead end-to-end quality improvement projects on HEDIS, CMS Stars, and regulatory compliance
• 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 as 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
• 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
  
  

Environmental Job Requirements and Working Conditions

• The total pay range for this role is $25.71 - $32.99 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. The home office is located at 600 City Parkway West 10th Floor, Orange, CA 92868.
• This position requires up to 25% travel to provider offices in the Inland Empire area.

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 us at humanresourcesdept@astranahealth.com 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.