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Quality Care Improvement Specialist II

Astrana Health, Inc.

RI, Rhode Island

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JOB DETAILS
SALARY
$32–$39 Per Hour
SKILLS
Analysis Skills, Billing Records, Centers for Medicare and Medicaid Services (CMS), Clinical Outcomes, Clinical Study Publications, Communication Skills, Compensation Management, Content Management Systems (CMS), Data Analysis, Data Quality, Detail Oriented, Documentation, Documentation Standards, Electronic Design, Environmental Work, Financial Analysis, Financial Management, Financial Operations, HIPAA (Health Insurance Portability and Accountability Act), Health Plan, Healthcare, Healthcare Effectiveness Data and Information Set (HEDIS), Healthcare Quality, Incentive Programs, Leadership, Managed Care, Medicaid, Medical Record System, Medical Records, Mentoring, Multitasking, National Committee for Quality Assurance (NCQA), Operational Improvement, Operational Strategy, Operations Processes, Organizational Skills, Outpatient Care, Patient Care, Performance Analysis, Performance Management, Portuguese Language, Presentation/Verbal Skills, Primary Care, Process Improvement, Project Planning, Quality Management, Quality Metrics, Service Delivery, Spanish Language, Team Building, Team Player, Training/Teaching, Trend Analysis, Willing to Travel
LOCATION
RI, Rhode Island
POSTED
9 days ago

Description


The Quality Care Improvement Specialist II develops, recommend, and implement interventions at the practice and membership level to improve quality and operational efficiency. You'll collaborate with practices to facilitate redesign efforts, support care teams, introduce population health management and support achievement towards improved financial, operational processes and clinical outcomes. This role is integral in supporting our mission to advance quality care across our network. Reporting to the Manager 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 ), Managed Medicaid, Commercial, and additional health plan quality metrics. 

What You'll Do


  • Partner with provider practices onsite and remotely 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
  • Lead, mentor, and guide the Quality Care Improvement Specialist team to achieve performance and quality goals
  • Act as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standards
  • Develop and execute set of intervention work plans to drive practice and improve quality measures and transformation
  • Develop and implement workflow design and redesign, including electronic health record (EHR) optimization, clinical documentation, billing practices, assessments, financial analyses, and financial performance improvement and reporting
  • 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 may be 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 
  • 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 Portuguese (preferred but not required)
  • 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


  • 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 25% travel to provider offices in the Rhode Island area. The home office is located at 1301 Atwood Avenue, Suite 206N, Johnston, RI 02919.
  • The target pay range for this role is between $32.00 - $39.00 per hour.  Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
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. 

About the Company

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Astrana Health, Inc.