Remote Clinical Quality Improvement Coordinator

Guidehealth • Dallas, TX

3d • Remote

About The Position

Guidehealth is seeking a remote Clinical Quality Improvement Coordinator to act as a Subject Matter Expert (SME) on QI measures, services, customers, and quality initiatives for various commercial and governmental payers. In this role, you will proactively engage with patients to identify and address quality gaps, educate them on preventive care, schedule necessary appointments, and facilitate adherence to treatment plans. You will collect quality data from various sources including EMR, claims, and provider outreach, and manage daily work using multiple systems such as EMR systems, payer portals, vendor platforms, Guidehealth applications, and Microsoft 365. You will work with patient lists, gap lists, health data, and medical records, leveraging all quality-related resources to ensure accuracy and completeness. Prioritizing daily work to meet reporting deadlines, communicating quality performance and improvement strategies, and following established policies and procedures are key. You will also collaborate with customers, payers, and co-workers, and participate in departmental and payer-sponsored webinars and trainings. Professional communication and building positive relationships are essential.

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.
• Employees are expected to adapt to evolving business needs, step in to support cross-functional initiatives, and contribute beyond traditional role boundaries when needed.
• Employees must be accessible during our stated working hours.
• Employees are asked to join virtual meetings with their cameras on.

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 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.

Benefits

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Comprehensive Medical, Dental, and Vision plans
• 401(k) plan includes a 3% employer match to your 6% contribution
• Life and Disability insurance
• Voluntary Life options
• Employee Assistance Program (EAP)
• Paid time off plans
• Paid parental leave
• Various resources dedicated to your learning and development

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree