Clinical Quality Improvement Coordinator

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

📋 Description

• Operate in a completely remote setting while engaging virtually with the company and your team during your daily tasks.

• Serve as the Subject Matter Expert (SME) on the full range of QI measures, services, customers, and quality initiatives across various commercial and governmental payers.

• Implement proactive patient outreach initiatives aimed at identifying and addressing quality gaps, educating patients on preventive care measures, scheduling necessary screenings or appointments, and supporting adherence to treatment plans, thus contributing to improved health outcomes and closing quality gaps.

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

• Oversee daily tasks using multiple systems and applications, including EMR systems, payer portals, vendor platforms, Guidehealth applications, and Microsoft 365 for Excel, Word, PowerPoint, and Teams for messaging and meetings.

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

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

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

• Convey quality performance metrics, barriers, 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.

• Engage in all departmental and payer-sponsored webinars, trainings, and support calls throughout the year.

• Communicate in a professional manner and foster positive relationships with co-workers, customers, providers, and support staff.

⛳️ Requirements

• Associate degree or higher in a related field or certification/licensure as a professional (CMA, LPN).

• A minimum of 1-3 years of experience in a healthcare environment; experience in working/charting/data abstraction via EMR systems, along with knowledge of medical terminology, quality measures, and medical billing/coding.

• At least 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, utilizing Excel and PowerPoint, and navigating multiple systems and applications.

• Highly skilled in both verbal and written communication.

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

• Ability to collaborate effectively with others and work harmoniously with management, colleagues, and customers.

🏝️ Benefits

• Work from Home: Guidehealth is a fully remote organization.

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

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

• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments.

• Additionally, we offer 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 assist you during challenging times.

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

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

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