Job Description

Quality Care Improvement Specialist I

Department: Quality - Risk Adjustment

Employment Type: Full Time

Location: 1301 Atwood Avenue, Suite 206N, Johnston, RI 02919

Reporting To: Leigh Nyahe

Compensation: $25.00 - $29.00 / hour

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

What You'll Do

• Support day-to-day execution of quality improvement programs, provider performance initiatives, and population health strategies.
• Monitor provider performance against HEDIS, Medicare Stars, Medicaid, Commercial, and other quality measures; analyze results and recommend improvement opportunities.
• Collaborate with providers and practice staff to implement care gap closure, outreach, education, and quality improvement interventions that support achievement of performance targets.
• Collect, validate, and submit medical record documentation and quality data to ensure accurate reporting, measurement, and compliance.

• Partner with provider practices through onsite and virtual engagement to improve quality performance, operational effectiveness, and patient outcomes.
• Provide education and serve as a subject matter resource on HEDIS, Medicare Stars, NCQA standards, documentation requirements, quality reporting, and performance improvement strategies.
• Present performance results, best practices, and recommendations while maintaining strong relationships with providers, health plans, and internal stakeholders.

• Support practice transformation initiatives through workflow analysis, process redesign, EHR optimization, documentation improvement, and population health management activities.
• Develop and implement improvement plans, identify performance barriers, and collaborate with providers and care teams to drive sustainable quality and operational outcomes.
• Support projects and initiatives designed to enhance service delivery, clinical quality, patient experience, and overall practice performance.

• Support quality audits, medical record reviews, and regulatory compliance activities in accordance with NCQA, CMS, HIPAA, and health plan requirements.
• Maintain accurate documentation of quality initiatives and provider engagement activities while identifying opportunities to improve operational effectiveness.
• Participate in provider, training, and organizational meetings and perform other duties or special projects as assigned.

Qualifications

• Bachelor's degree in Healthcare Administration, Public Health, Business Administration, Nursing, or a related field preferred, or equivalent combination of education and relevant experience.

• At least 3 years of experience in healthcare, managed care, population health, quality improvement, provider engagement, or related healthcare programs.
• At least 1 year of experience supporting HEDIS, quality improvement, Medicare Stars, or quality reporting initiatives.
• Experience working with provider practices, IPAs, MSOs, health plans, or outpatient clinical settings preferred.
• Experience analyzing provider performance data and supporting quality improvement interventions preferred.
• Familiarity with practice management operations, workflow improvement, and population health strategies preferred.

• No certification is required.
• Certified Professional in Healthcare Quality (CPHQ) or other relevant healthcare quality certification preferred.

• Strong knowledge of managed care operations, quality improvement programs, HEDIS, Medicare Stars, NCQA standards, HIPAA requirements, population health management, and quality reporting methodologies.
• Working knowledge of quality measure specifications, practice transformation, workflow redesign, EHR optimization, and documentation improvement strategies.
• Strong analytical, critical-thinking, problem-solving, and organizational skills, with the ability to identify opportunities, implement solutions, and manage multiple priorities effectively.
• Excellent provider relationship management, stakeholder engagement, communication, presentation, and interpersonal skills, with the ability to work independently and collaboratively across provider groups and internal departments.
• Intermediate proficiency in Microsoft Excel, PowerPoint, reporting tools, and data analytics applications.
• Demonstrated professionalism, accountability, integrity, attention to detail, and commitment to high-quality outcomes.
• Fluency in Spanish and/or Portuguese preferred.

• Experience supporting HEDIS, Medicare Stars, quality improvement, population health, provider performance, and practice transformation initiatives.
• Experience working within Medicare Advantage, Medicaid, Commercial, or other managed care environments.
• Experience conducting provider education, staff training, workflow redesign, and quality performance improvement activities.
• Experience collecting, validating, analyzing, and reporting medical record and quality performance data to support operational and quality outcomes.

Job Benefits

• This position may collaborate with providers, practice staff, health plans, and internal stakeholders in remote, office, and provider office settings.
• The employee must reside in Rhode Island, Massachusetts, or Connecticut.
• Travel up to 50% may be required to support provider practices and organizational initiatives.
• The employee must be able to attend meetings in person or virtually based on business needs.
• Work requires regular use of computers, electronic health record systems, reporting platforms, and virtual communication tools.
• The employee must comply with Astrana Health policies and procedures regarding patient privacy, protected health information, and all applicable federal and state regulations.