Remote Clinical Quality Improvement Coordinator

Guidehealth • Atlanta, GA

10d • Remote

About The Position

As outlined below, provide quality improvement focused work for all delegated entities and support for ACO quality reporting for all contracted ACOs. WHAT YOU’LL BE DOING ● Work in a fully remote environment and virtually engage with company and team in your daily work. ● Serve as a Subject Matter Expert (SME) across Medicare Advantage STAR, Commercial, Medicaid, and MSSP ACO quality measures, services, customers, and quality improvement initiatives under various commercial and governmental payers. ● Conduct proactive patient outreach initiatives to identify and address quality gaps across Medicare Advantage, Commercial, Medicaid, and MSSP populations, engaging patients to educate them on preventive care measures, schedule necessary screenings or appointments, and support adherence to treatment plans and medications to improve health outcomes. ● Support ACO quality reporting and performance improvement activities, including MSSP reporting requirements and payer-specific submissions. ● Collect and abstract quality data using multiple data sources including EMR systems, claims data, provider outreach, payer portals, and patient engagement workflows. ● Manage daily work using multiple systems and applications — EMR platforms, payer/vendor portals, Guidehealth applications, Microsoft 365 (Excel, Word, PowerPoint), Outlook, and Teams. ● Work with patient lists, gap lists, sourced health data, medical records, and performance dashboards related to Medicare, Commercial, Medicaid, and MSSP populations. ● Leverage all quality-related resources to ensure accuracy and completeness of work — measure specifications (NCQA/HEDIS®, CMS, MSSP), coding guidance, project workflows, and quick-reference materials. ● Prioritize daily work to meet various quality reporting deadlines, including STAR Ratings, Medicaid quality programs, Commercial payer initiatives, and MSSP ACO reporting timelines. ● Communicate quality performance trends, barriers, and improvement strategies internally and with customers, providers, and payers. ● Follow all established policies and procedures for QI workflows to ensure compliance and success across multiple payer programs. ● Collaborate with customers, payers, providers, and internal teams to drive quality performance improvement. ● Participate in departmental, payer-sponsored, and ACO-related trainings, webinars, and support calls throughout the year. ● Communicate professionally and build strong working relationships with co-workers, customers, providers, and care teams. WHAT SUCCESS LOOKS LIKE IN 3 MONTHS Complete QI Department training, orientation and shadowing. Have a solid understanding of QI department scope of work and assigned customer. Begin to take QI responsibility for assigned customer while partnering w/ a seasoned QI co-worker. Begin managing, collecting and reporting quality data per established workflows. IN 6 MONTHS Moving towards independence w/ QI ownership of assigned IPA w/ periodic support from QI team. Taking lead or co-lead on QI portion of customer meetings and meeting preparations. Occasional support/direction needed. IN 12 MONTHS Fully independent with minimal direction and support needed.

Requirements

• Associate degree or greater in related field
• 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.

Nice To Haves

• Certified/licensed professional-CMA, LPN
• 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

• Work in a fully remote environment and virtually engage with company and team in your daily work.
• Serve as a Subject Matter Expert (SME) across Medicare Advantage STAR, Commercial, Medicaid, and MSSP ACO quality measures, services, customers, and quality improvement initiatives under various commercial and governmental payers.
• Conduct proactive patient outreach initiatives to identify and address quality gaps across Medicare Advantage, Commercial, Medicaid, and MSSP populations, engaging patients to educate them on preventive care measures, schedule necessary screenings or appointments, and support adherence to treatment plans and medications to improve health outcomes.
• Support ACO quality reporting and performance improvement activities, including MSSP reporting requirements and payer-specific submissions.
• Collect and abstract quality data using multiple data sources including EMR systems, claims data, provider outreach, payer portals, and patient engagement workflows.
• Manage daily work using multiple systems and applications — EMR platforms, payer/vendor portals, Guidehealth applications, Microsoft 365 (Excel, Word, PowerPoint), Outlook, and Teams.
• Work with patient lists, gap lists, sourced health data, medical records, and performance dashboards related to Medicare, Commercial, Medicaid, and MSSP populations.
• Leverage all quality-related resources to ensure accuracy and completeness of work — measure specifications (NCQA/HEDIS®, CMS, MSSP), coding guidance, project workflows, and quick-reference materials.
• Prioritize daily work to meet various quality reporting deadlines, including STAR Ratings, Medicaid quality programs, Commercial payer initiatives, and MSSP ACO reporting timelines.
• Communicate quality performance trends, barriers, and improvement strategies internally and with customers, providers, and payers.
• Follow all established policies and procedures for QI workflows to ensure compliance and success across multiple payer programs.
• Collaborate with customers, payers, providers, and internal teams to drive quality performance improvement.
• Participate in departmental, payer-sponsored, and ACO-related trainings, webinars, and support calls throughout the year.
• Communicate professionally and build strong working relationships with co-workers, customers, providers, and care teams.

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.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

What This Job Offers

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