Remote Clinical Quality Improvement Coordinator

About the role

In this position, you will serve as a vital member of the Guide Health team, focusing on enhancing clinical quality through data-driven initiatives. You will engage with patients and healthcare providers to identify and address quality gaps, ensuring adherence to treatment plans and preventive care measures. Your expertise will be essential in managing quality improvement measures across various payers, both commercial and governmental. This role requires a strong commitment to improving health outcomes and a collaborative approach to problem-solving.

Key facts

What you'll do

• Act as a Subject Matter Expert (SME) on quality improvement measures, services, and initiatives related to different payers.
• Initiate proactive outreach to patients to identify quality gaps and educate them on preventive care, scheduling necessary screenings, and ensuring adherence to treatment plans.
• Gather quality data from multiple sources, including Electronic Medical Records (EMR), claims, and provider outreach, to inform quality improvement efforts.
• Utilize various systems and applications, such as EMR systems, payer portals, and Guide Health applications, to manage daily tasks effectively.
• Work with patient lists and health data to prioritize and execute quality improvement projects.
• Ensure the accuracy and completeness of work by leveraging resources related to NCQA/HEDIS® specifications and coding documents.
• Communicate quality performance metrics, barriers, and strategies for improvement to both internal teams and external customers.
• Adhere to established policies and procedures for quality improvement workflows, ensuring successful outcomes.
• Collaborate with customers, payers, and co-workers to achieve daily objectives and enhance quality initiatives.
• Participate in webinars, training sessions, and support calls organized by the department and payers throughout the year.
• Build and maintain professional relationships with co-workers, customers, and healthcare providers to foster a collaborative work environment.

Requirements

• An Associate's degree or higher in a relevant field, or a certification/license as a CMA or LPN.
• At least 1-3 years of experience in a healthcare environment, with familiarity in charting and data abstraction using EMR systems.
• A minimum of 2 years of experience specifically in Medicare Advantage quality data abstraction and patient outreach.
• Proficiency in managing technical aspects of the role, including working with health data and utilizing Excel and PowerPoint.
• Excellent verbal and written communication skills, with a strong emphasis on attention to detail and organization.
• Ability to work collaboratively with management, colleagues, and customers to achieve common goals.

Nice to have

• Experience or knowledge in quality improvement initiatives and data submissions for various health insurance payers.
• Extensive background in quality database entries and reporting processes.
• Familiarity with interpreting and reporting quality information, along with training staff on these processes.
• Proficiency in using Electronic Medical Record (EMR) software and cloud-based platforms.

Skills & tools

• Strong analytical skills for data collection and interpretation.
• Proficiency in Microsoft 365 applications, including Excel, Word, PowerPoint, and Teams.
• Familiarity with quality improvement frameworks and methodologies.
• Excellent organizational skills to manage multiple projects and deadlines.

Practical notes

• The base pay for this position ranges from $28 to $30 per hour, with payments made bi-weekly.
• Final compensation will be determined based on various factors, including experience, education, and location.
• Guide Health is committed to providing a supportive work environment that prioritizes employee well-being and professional development.

At Guide Health, we value diversity, inclusion, and belonging. We are an equal opportunity employer and are dedicated to making employment decisions without discrimination based on various protected characteristics. Our commitment extends to ensuring a workplace that respects and values the unique perspectives of each team member.

As a company that handles sensitive healthcare data, we prioritize the protection of patient and company information. All employees are required to adhere to security policies to safeguard personal health information (PHI) and personally identifiable information (PII).

In addition to a competitive salary, Guide Health offers a comprehensive benefits package for full-time employees, including medical, dental, and vision coverage, a 401(k) plan with employer matching, life and disability insurance, and paid parental leave. We also provide resources for professional growth and development, ensuring that our employees have the support they need to thrive in their careers.