About this role
This role is integral in supporting our mission to advance quality care across our network, particularly within the Southern California IPAs. Reporting to the Supervisor 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 & D), and overall health plan quality metrics. Partner with provider practices 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 Act as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standards Conduct comprehensive training for PCPs and specialists on:
- 1. Quality Measures
- 2. HEDIS and CMS Star Ratings
- 3. Performance-Based Incentive Programs
- 4. Data Accuracy and Documentation Standards Perform additional duties and projects as assigned