Clinical Quality Improvement Coordinator - Eye Exam Specialist

Company Description

WHO IS GUIDEHEALTH? 

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.  

Join us as we put healthcare on a better path!!  

Job Description

The Clinical Quality Improvement Coordinator - Eye Exam Specialist is primarily responsible for performing scheduled diabetic eye exams (retinal screenings) for members at provider practices and patient homes, using imaging equipment supplied and trained on by the company. Travel to and from appointments is covered by the company. On days without scheduled eye exam appointments, this role supports the broader quality improvement initiatives across delegated entities and contracted Accountable Care Organizations (ACOs), including quality reporting, performance improvement, patient outreach, quality gap closure, and data abstraction activities across Medicare Advantage STAR, Commercial, Medicaid, and MSSP ACO quality programs. 

This role also serves as a quality improvement resource for internal teams, customers, providers, payers, and care teams on non-appointment days. This includes working with multiple systems and data sources to identify quality gaps, support patient engagement, collect and validate quality data, and assist with payer-specific and ACO reporting requirements. 

Success in this role requires comfort operating specialized retinal imaging equipment (full training and camera provided), strong attention to detail, willingness to travel daily to provider practices and patient homes for scheduled eye exam appointments, knowledge of healthcare quality measures, comfort working with health data and multiple systems, strong communication skills, and the ability to manage deadlines in a field/remote hybrid environment. 

WHAT YOU'LL BE DOING

• This role will require up to 100% field travel in the Philadelphia, PA area. Qualified candidates must reside locally.
• Working in a field-based role, traveling to provider practices and patient homes for scheduled eye exam appointments, while engaging virtually with team members, internal partners, customers, providers, payers, and care teams on non-appointment days.
• Serving as a subject matter resource across Medicare Advantage STAR, Commercial, Medicaid, and MSSP ACO quality measures, services, customers, and quality improvement initiatives under commercial and governmental payer programs.
• Traveling to provider practices and patient homes on a scheduled appointment basis to perform diabetic eye exams (retinal screenings) using company-provided imaging equipment and supporting the closure of eye exam and related quality gaps.
• Completing company-provided training on retinal imaging equipment and eye exam procedures prior to conducting exams independently and maintaining competency through ongoing training as needed.
• Conducting proactive patient outreach on days without scheduled eye exam appointments to identify and address quality gaps across Medicare Advantage, Commercial, Medicaid, and MSSP populations.
• Educating patients on preventive care measures, assisting with scheduling necessary screenings or appointments, and supporting adherence to treatment plans and medications to improve health outcomes.
• Managing a daily eye exam appointment schedule, confirming appointments with practices and patients in advance, and coordinating travel logistics, with all mileage and travel expenses associated with eye exam visits being covered by the company.
• Supporting ACO quality reporting and performance improvement activities, including MSSP reporting requirements and payer-specific submissions.
• Collecting, reviewing, and abstracting quality data using multiple data sources, including EMR systems, claims data, provider outreach, payer portals, medical records, patient engagement workflows, and internal applications.
• Managing daily work on non-appointment days using multiple systems and applications, including EMR platforms, payer and vendor portals, Guidehealth applications, Microsoft 365, Outlook, and Teams.
• Working with patient lists, gap lists, sourced health data, medical records, and performance dashboards related to Medicare, Commercial, Medicaid, and MSSP populations.
• Using quality-related resources to support the accuracy an