Quality Care Improvement Specialist

Astrana Health

Quality Care Improvement Specialist responsible for healthcare quality improvements and metrics at Astrana Health. Leading initiatives to enhance HEDIS and CMS ratings within Southern California IPAs.

Posted 7/31/2026full-timeOrange • California • 🇺🇸 United StatesMid-LevelSenior💰 $24 - $34 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in HEDIS, quality improvement initiatives, and healthcare documentation standards while effectively collaborating with provider offices and health plans to enhance care quality and compliance. Proficient in data analysis, reporting, and training on quality measures and coding requirements.

Highest-signal resume keywords

HEDIS ExperienceQuality Improvement InitiativesHealthcare Documentation StandardsData Analysis and ReportingFluent in Spanish and/or Chinese

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Quality Performance MetricsCoding AccuracyCare Gap ClosureMedical Record ValidationData Submission and VerificationHEDIS Record AuditingPerformance-Based Incentive ProgramsPrimary Source VerificationQuality Measures EducationManaged Care Standards

Soft Skills

Analytical SkillsCommunication SkillsPresentation SkillsInitiativeCollaborative Mindset

Tools & Technologies

HEDIS DashboardsScorecardsReporting ToolsData Management Systems

Industry Keywords

CMS StandardsNCQA StandardsHIPAA ComplianceIPA/MSO/Health Plan Environments

About the role

Key responsibilities & impact

Build and maintain strong relationships with provider offices and clinic leadership.
Conduct onsite and virtual provider outreach visits to review quality performance metrics, identify improvement opportunities, and retrieve relevant care gap closure data/records.
Collaborate with assigned provider offices and health plans to improve documentation, coding accuracy, and care gap closure.
Collect, review, and validate medical records to ensure accuracy and completeness for reporting purposes.
Educate providers and office staff on quality measures, documentation standards, coding requirements, and best practices.
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.
Assist in developing QI initiatives such as outreach campaigns, provider education, and workflow optimization.
Assist practices with workflow optimization, patient outreach strategies, and quality improvement interventions.
Serve as a quality performance resource to assigned health plan partners, provider groups, clinics, and MSOs, providing and presenting HEDIS performance scorecards monthly.
Monitor HEDIS progress dashboards and address data gaps prior to final submission.
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.
Act as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standards.
Conduct comprehensive training for PCPs and specialists on Quality Measures, HEDIS and CMS Star Ratings, Performance-Based Incentive Programs, Data Accuracy and Documentation Standards.
Perform additional duties and projects assigned.

Requirements

What you’ll need

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
Fluent in Spanish and/or Chinese (Mandarin/Cantonese)

Benefits

Comp & perks

The total pay range for this role is $24 - $34 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 20% travel to provider offices in the San Diego area.
Equal Employment Opportunity and Affirmative Action employer.