Remote Clinical Quality Improvement Coordinator

As outlined below provide quality improvement focused work for all delegated entities and support for ACO quality reporting for all contracted ACOs.

WHAT YOULL 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.

Qualifications :

WHAT YOULL NEED TO HAVE

• 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.

WOULD LOVE FOR YOU TO HAVE

• 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

Additional Information :

All your information will be kept confidential according to EEO guidelines.

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. 
• This is what it means to be ALIVE with purpose. This is how we thrive together at Guidehealth. 

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 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.

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.

COMPENSATION:

The listed compensation range listed is paid bi-weekly per our standard payroll practices. 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.

OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT 

Diversity inclusion and belonging are at the core of Guidehealths values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race religious creed color age sex sexual orientation and identity national origin citizenship religion marital status familial status physical sensory or medical disability Family and Medical Leave military or veteran status pregnancy childbirth or other related medical conditions or any other classification protected by federal state and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring placement promotion transfer demotion layoff termination recruitment advertising pay and other forms of compensation training and general treatment during employment. 

OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealths custodianship as well as Guidehealth Intellectual Properties.  For any security-specific roles the responsibilities would be further defined by the hiring manager. 

As a remote-first organization handling sensitive healthcare data Guidehealth verifies candidate identity at multiple stages of the hiring and onboarding to safeguard patient privacy data security and compliance requirements.

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 100 mbps download 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements. 

SECONDARY EMPLOYMENT

At Guidehealth we value transparency and collaboration as part of our commitment to excellence. As your primary employer we kindly ask all team members to disclose any secondary employment regardless of whether it may present a potential conflict of interest. 

To ensure smooth teamwork and availability employees must be accessible during our stated working hours. We foster connection and engagement by asking team members to join virtual meetings with their cameras on.

Remote Work :

Yes

Employment Type :

Full-time