Quality Care Improvement Specialist

Job Title: Quality Care Improvement Specialist *Hybrid*
Department: Quality – Quality Care Improvement      

About the Role:    

We are currently seeking a highly motivated Quality Care Improvement Specialist. This role will report to the Director – Quality Care Improvement and enable us to continue to scale in the healthcare industry. You will be responsible for working with our network providers in improving quality of care through quality improvement activities that will encompass HEDIS, CMS Star Rating, and health plan quality performance reporting. This is a hybrid role where the expectation is to work both in office and at home on a weekly basis.  This position will also require some travel to provider sites dependent on projects.    

What You'll Do:     

• Collect and collate appropriate data from IPA network providers for HEDIS measures
• Collect medical records, conduct reviews and ensure accuracy of documentation for reporting
• Collect, summarize and trend provider performance data to include provider education
• Participate in ongoing discussions concerning data collections and analysis for HEDIS
• Assist in planning and implementation of projects to improve delivery of services and quality of care
• Understand the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards and HIPAA
• Provide in-service training to providers regarding HEDIS and CMS Star Measures
• Generate and maintain accurate weekly/monthly/quarterly report of activities
• Conduct Provider Training (PCPs & Specialist) that would include but not limited to:
  • Quality Measures
  • HEDIS and STAR measures
  • Incentive Programs
  • Data and documentation integrity and accuracy
• Attend to health plans, provider, and interdepartmental calls
• Comply with department policy and procedures
• Perform other duties, projects, and actions as assigned

Qualifications:     

• Bachelor’s degree or equivalent years of experience
• 3-5 years of IPA/MSO/HP or general healthcare experience
• At least one (1) year of HEDIS related experience
• Experience explaining data reports to practitioners and educating providers
• Experience using Microsoft applications such as Word, Excel and Outlook
• Ability to drive in the state of California

You're great for this role if:     

• You are fluent in Spanish and/or Chinese
• You have experience in data analytics and reporting
• You have knowledge of practice management and/or financial aspects of the practice
• You have excellent analytical critical reasoning and interpersonal communication skills
• You thrive in a fast-paced environment
• You are able to keep a high level of confidence and discretion when dealing with sensitive matters relating to providers, members, business plans, strategies and other sensitive information

Who We Are:    

Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise in order to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.    

Our platform currently empowers over 10,000 physicians to provide care for ~1 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise in order to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.    

Our Values:    

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity and Excellence
• Be Innovative
• Work as One Team

Environmental Job Requirements and Working Conditions:    

• This position is in office with the option to be hybrid after an initial 30-day training period. The office is located at 1680 S. Garfield Ave. #205, Alhambra, CA 91801. The shift will typically be Monday - Friday from 8am to 4:30pm.
• The total compensation target pay range for this role is: $30.00 - $35.00/hr. The salary range represents our national target range for this role

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon 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 on the basis of 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.