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Company

Astrana Health · 23 hours ago

Quality Care Improvement Specialist (Remote - San Francisco, CA)

Alhambra, CA

Full-time

Remote

Mid Level

$30/hr - $35/hr

3+ years exp

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Responsibilities

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

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

HEDIS experienceData analyticsHealthcare experienceMicrosoft WordMicrosoft ExcelMicrosoft OutlookSpanish fluencyChinese fluencyPractice management knowledgeFinancial aspects knowledgeAnalytical reasoning skillsInterpersonal communication skills

Required

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

Preferred

You are fluent in Spanish and/or Chinese (Mandarin/Cantonese)

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