Remote Clinical Quality Improvement Coordinator

ALIVE with Purpose

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.

About the role

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.

Responsibilities

• Work in a fully remote environment and virtually engage with company and team in your daily work.
• Subject Matter Expert (SME) on entire scope of QI measures, services, customers and quality initiatives under various commercial and governmental payers.
• Conduct proactive patient outreach initiatives to identify and address quality gaps, engaging with patients to educate them on preventive care measures, schedule necessary screenings or appointments, and facilitate adherence to treatment plans, thereby contributing to improved health outcomes and closing quality gaps.
• Collect quality data using various methods of data sourcing-EMR, claims, provider outreach.
• Manage daily work using multiple systems and applications-EMR systems, payer portals, vendor platforms, Guidehealth applications, Microsoft 365 for Excel, Word and PowerPoint and Teams for messaging and meetings.
• Work with patient lists, gap lists, sourced health data and medical records in your daily work.
• Leverage all quality related resources to ensure accuracy and completeness of work measure/project instructions, NCQA/HEDIS® specifications, coding documents, quick reference guides.
• Prioritize daily work to meet various quality reporting deadlines and requirements.
• Communicate quality performances, barriers and improvement strategies both internally and with customers.
• Follow all established policies and procedures for various QI workflows to ensure overall success.
• Collaborate with customers, payers, co-workers to accomplish daily work.
• Participate in all departmental and payer sponsored webinars/trainings/support calls throughout the year.
• Communicate professionally and develop positive relationships with co-workers, customers, providers and providers’ support staff.

Qualifications

• Associate degree or greater in related field or certified/licensed professional-CMA, LPN.
• 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 with others and work effectively with management, co-workers, and customers.
• 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.

Benefits

• Comprehensive Medical, Dental, and Vision plans.
• 401(k) plan including a 3% employer match to your 6% contribution.
• Life and Disability insurance.
• Employee Assistance Program (EAP).
• Paid time off plans.
• Paid parental leave.
• Variety of resources dedicated to learning and development.

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.

Secondary Employment

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 Technical Requirements

• Required internet speed is a minimum of 100 mbps download, 10 mbps upload.
• New employees provided with 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.