Remote Clinical Quality Improvement Coordinator

Guidehealth • Dallas, TX

3d • Remote

About The Position

The Clinical Quality Improvement Coordinator works in a fully remote environment and serves as a subject matter expert on the scope of quality improvement measures, services, customers, and initiatives across commercial and governmental payers. The role conducts proactive patient outreach to identify and address quality gaps, educate patients about preventive care, schedule screenings or appointments, and support adherence to treatment plans. It collects quality data from sources such as electronic medical records, claims, and provider outreach; manages daily work across multiple systems and applications; and uses quality resources and specifications to ensure accurate, complete work. The coordinator prioritizes work to meet quality reporting deadlines, communicates performance, barriers, and improvement strategies, follows established workflows, and collaborates with customers, payers, coworkers, providers, and provider support staff. The position also participates in departmental and payer-sponsored training and support sessions throughout the year.

The role requires protecting patient and company data, including PHI and PII, and following applicable security policies and procedures. Guidehealth provides necessary work equipment; employees provide their own internet connection, with a minimum required speed of 100 Mbps download and 10 Mbps upload. Employees are expected to be accessible during stated working hours, disclose secondary employment, and participate in virtual meetings with cameras on.

Requirements

• Associate degree or higher in a related field, or professional certification/licensure such as CMA or LPN.
• Minimum 1–3 years of experience in a healthcare setting, including experience working or charting in EMR systems or performing data abstraction; knowledge of medical terminology, quality measures, and medical billing/coding.
• At least 2 years of experience in Medicare Advantage quality data abstraction and patient outreach.
• Technical proficiency managing health data, working in Excel and PowerPoint, and navigating multiple systems and applications.
• Strong verbal and written communication skills.
• Strong attention to detail, organization, and ability to meet hard deadlines.
• Ability to collaborate and work effectively with management, coworkers, and customers.
• Own an internet connection with at least 100 Mbps download and 10 Mbps upload.

Nice To Haves

• Knowledge of or experience with quality improvement initiatives and data submissions required by health insurance payers.
• Extensive experience with quality database entries and reporting.
• Experience interpreting and reporting quality information and training staff.
• Proficiency with EMR software and cloud platforms.

Responsibilities

• Serve as a subject matter expert on quality improvement measures, services, customers, and initiatives across commercial and governmental payers.
• Conduct patient outreach to identify and address quality gaps, educate patients on preventive care, schedule screenings or appointments, and support adherence to treatment plans.
• Collect quality data from EMRs, claims, provider outreach, and other sources.
• Manage daily work across EMR systems, payer portals, vendor platforms, Guidehealth applications, and Microsoft 365 tools.
• Work with patient lists, gap lists, sourced health data, and medical records.
• Use quality measure and project instructions, NCQA/HEDIS® specifications, coding documents, and reference guides to ensure accuracy and completeness.
• Prioritize daily work to meet quality reporting deadlines and requirements.
• Communicate quality performance, barriers, and improvement strategies internally and with customers.
• Follow established policies and procedures for quality improvement workflows.
• Collaborate with customers, payers, coworkers, providers, and provider support staff to accomplish daily work.
• Participate in departmental and payer-sponsored webinars, trainings, and support calls.
• Communicate professionally and develop positive working relationships.
• Follow security policies and procedures to protect PHI, PII, and Guidehealth intellectual property.
• Remain accessible during stated working hours and disclose secondary employment.

Benefits

• Medical, dental, and vision insurance.
• 401(k) plan with a 3% employer match when the employee contributes 6%.
• Life and disability insurance, with voluntary life insurance options.
• Employee Assistance Program (EAP).
• Paid time off plans.
• Paid parental leave.
• Learning and development resources.
• Remote work and employer-provided equipment.

What This Job Offers

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