Clinical Quality Improvement Coordinator

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Engage with the company and your team in a fully remote setting for your daily tasks.

• Act as a Subject Matter Expert (SME) on the comprehensive range of QI measures, services, clients, and quality initiatives across various commercial and governmental payers.

• Execute proactive patient outreach efforts to pinpoint and remedy quality gaps, educating patients on preventive care measures, scheduling essential screenings or appointments, and ensuring adherence to treatment plans, thereby enhancing health outcomes and closing quality gaps.

• Gather quality data through diverse data sourcing methods, including EMR, claims, and provider outreach.

• Organize daily tasks utilizing multiple systems and applications, such as EMR systems, payer portals, vendor platforms, Guidehealth applications, and Microsoft 365 tools like Excel, Word, PowerPoint, and Teams for communication and meetings.

• Work with patient lists, gap lists, sourced health data, and medical records as part of your daily responsibilities.

• Utilize all quality-related resources to guarantee the accuracy and completeness of work measure/project instructions, NCQA/HEDIS® specifications, coding documents, and quick reference guides.

• Prioritize daily tasks to fulfill various quality reporting deadlines and requirements.

• Report on quality performance, obstacles, and improvement strategies both internally and to customers.

• Adhere to all established policies and procedures for various QI workflows to ensure overall success.

• Collaborate with customers, payers, and co-workers to achieve daily objectives.

• Attend all departmental and payer-sponsored webinars, training sessions, and support calls throughout the year.

• Maintain a professional demeanor and cultivate positive relationships with co-workers, customers, providers, and their support staff.

⛳️ Requirements

• An Associate degree or higher in a related field, or a certified/licensed professional such as CMA or LPN.

• At least 1-3 years of experience in a healthcare setting, including time spent working/charting/data abstraction via EMR systems, along with knowledge of medical terminology, quality measures, and medical billing/coding.

• A minimum of 2 years of experience in Medicare Advantage quality data abstraction and patient outreach.

• Proficient in managing the technical aspects of this role, including working with health data, using Excel and PowerPoint, and navigating multiple systems and applications.

• Highly adept in both verbal and written communication.

• Exceptional attention to detail, well-organized, and capable of meeting strict deadlines.

• Ability to collaborate with others and work effectively with management, co-workers, and customers.

🏝️ Benefits

• Work from Home: Guidehealth operates as a fully remote company, granting you the flexibility to reduce commuting time and focus more on your professional aspirations and personal needs.

• Keep Health a Priority: We provide comprehensive Medical, Dental, and Vision plans to ensure you are well-covered.

• Plan for the Future: Our 401(k) plan offers a 3% employer match on your 6% contribution.

• Have Peace of Mind: We include Life and Disability insurance for those unexpected moments, along with voluntary Life options to protect you and your loved ones.

• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is available to help you navigate challenging times.

• Take Time for Yourself: We provide paid time off plans to support your work-life balance and help you achieve your personal goals.

• Support Your New Family: Guidehealth offers paid parental leave to ensure you have the time you need.

• Learn and Grow: Your professional development is a priority for us. Guidehealth offers various resources dedicated to your learning and growth to advance your career with us.