Remote Clinical Quality Improvement Coordinator

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. 

Job Description

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.

Qualifications

WHAT YOU'LL 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.