Remote Clinical Quality Improvement Coordinator

Guidehealth•Dallas, TX

2d•Remote

About The Position

Guidehealth is seeking a Clinical Quality Improvement Coordinator to work in a fully remote environment. This role involves being a Subject Matter Expert (SME) on QI measures, services, customers, and quality initiatives for various payers. The coordinator will conduct proactive patient outreach to identify and address quality gaps, educate patients on preventive care, schedule appointments, and facilitate adherence to treatment plans. Responsibilities include collecting quality data from EMR, claims, and provider outreach, managing daily work using multiple systems (EMR, payer portals, vendor platforms, Guidehealth applications, Microsoft 365), and working with patient lists, gap lists, health data, and medical records. The role requires leveraging quality resources for accuracy, prioritizing work to meet deadlines, communicating quality performance and improvement strategies, and following established QI workflows. Collaboration with customers, payers, and coworkers is essential, as is participation in departmental and payer webinars/trainings. Professional communication and relationship development with coworkers, customers, and providers are key. Periodic travel may be required, and a valid driver's license and vehicle are necessary.

Requirements

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.

Nice To Haves

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.

Responsibilities

Act as a Subject Matter Expert (SME) on the 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.
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 with 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.