Remote Clinical Quality Improvement Coordinator

WHAT YOU'LL BE DOING

• Work in a fully remote environment and virtually engage with company and team in your daily work.
• Subject Matter Expert (SME) on entire scope of QI measures, services, customers and quality initiatives under various commercial and governmental payers.
• Conduct proactive patient outreach initiatives to identify and address quality gaps, engaging with patients to educate them on preventive care measures, schedule necessary screenings or appointments, and facilitate adherence to treatment plans, thereby contributing to improved health outcomes and closing quality gaps.
• Collect quality data using various methods of data sourcing-EMR, claims, provider outreach.
• Manage daily work using multiple systems and applications-EMR systems, payer portals, vendor platforms, Guidehealth applications, Microsoft 365 for Excel, Word and PowerPoint and Teams for messaging and meetings.
• Work with patient lists, gap lists, sourced health data and medical records in your daily work.
• Leverage all quality related resources to ensure accuracy and completeness of work measure/project instructions, NCQA/HEDIS® specifications, coding documents, quick reference guides.
• Prioritize daily work to meet various quality reporting deadlines and requirements.
• Communicate quality performances, barriers and improvement strategies both internally and with customers.
• Follow all established policies and procedures for various QI workflows to ensure overall success.
• Collaborate w/ customers, payers, co-workers to accomplish daily work.
• Participate in all departmental and payer sponsored webinars/trainings/support calls throughout the year.
• Communicate professionally and develop positive relationships with co-workers, customers, providers and providers' support staff.

WHAT YOU'LL NEED TO HAVE

• Associate degree or greater in related field or certified/licensed professional-CMA, LPN.
• Minimum 1-3 years of experience in healthcare setting; time spent working/charting/data abstraction via EMR system/s, knowledge of medical terminology, quality measures, medical billing/coding.
• Minimum 2 years' experience in Medicare Advantage Quality data abstraction and patient outreach
• Tech savvy in managing the technical side of this position-working with health data, working in excel and PowerPoint, navigating multiple systems and applications.
• Highly skilled in verbal and written communications.
• Strong attention to detail, organized and ability to meet hard deadlines.
• Ability to collaborate w/ others and work effectively with management, co-workers, and customers.
• Periodic travel may be required. Must have valid driver's license and vehicle.

WOULD LOVE FOR YOU TO HAVE

• Knowledge or experience in quality improvement initiatives and data submissions required by various health insurance payers.
• Extensive experience with quality database entries and reporting.
• Experience in interpreting and reporting quality information, as well as training staff.
• Proficiency in Electronic Medical Record (EMR) software and cloud platforms.

COMPENSATION

The base pay range for this role is between $28-$30 per hour paid bi-weekly. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

ALIVE with Purpose: How We Thrive at Guidehealth

At Guidehealth, our values come to life in everything we do.

• We are Driven by Accountability --- grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike.
• Always Growing, Always Learning --- staying curious and continuously improving inspires us to shape a better future for healthcare.
• With Collaborative Innovation, we solve problems creatively, making every experience better for our employees and the patients we serve.
• At Guidehealth, Every Voice Matters --- we believe our collective strength is rooted in the unique perspectives of each team member.
• And through Empathy in Action, we build stronger connections with those who count on us.

BENEFITS

While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company.
• Keep Health a Priority: Comprehensive Medical, Dental, and Vision plans.
• Plan for the Future: 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: Life and Disability insurance.
• Feel Supported When You Need It Most: Employee Assistance Program (EAP).
• Take Time for Yourself: Paid time off plans.
• Support Your New Family: Paid parental leave.
• Learn and Grow: Resources dedicated to your learning and development.

ADDITIONAL INFORMATION

• OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT: Diversity, inclusion, and belonging are at the core of Guidehealth's values.
• OUR COMMITMENT TO PROTECTION OF PATIENT AND COMPANY DATA: This position is responsible for following all Security policies and procedures.
• REMOTE WORK TECHNICAL REQUIREMENTS: Guidehealth is a fully remote company. We provide new employees with the necessary equipment. Employees provide their own internet connection (minimum 100 mbps download, 10 mbps upload).
• SECONDARY EMPLOYMENT: We kindly ask all team members to disclose any secondary employment.