Clinical Quality Improvement Coordinator - Eye Exam Specialist

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

📋 Description

• This position requires up to 100% field travel within the Philadelphia, PA region.

• Candidates must be local residents.

• In this field-based role, you will travel to provider practices and patient homes for scheduled eye exam appointments, while virtually engaging with team members, internal partners, customers, providers, payers, and care teams on days without appointments.

• Act as a subject matter expert on Medicare Advantage STAR, Commercial, Medicaid, and MSSP ACO quality measures, services, customers, and quality improvement initiatives under commercial and government payer programs.

• Travel to provider practices and patient homes on a scheduled basis to conduct diabetic eye exams (retinal screenings) using imaging equipment provided by the company, helping to close eye exam and related quality gaps.

• Complete company-provided training on retinal imaging equipment and eye exam procedures before conducting exams independently, and maintain competency through ongoing training as necessary.

• Engage in proactive patient outreach on days without scheduled appointments to identify and address quality gaps across Medicare Advantage, Commercial, Medicaid, and MSSP populations.

• Educate patients about preventive care measures, assist in scheduling necessary screenings or appointments, and support adherence to treatment plans and medications to enhance health outcomes.

• Manage a daily schedule for eye exam appointments, confirming appointments with practices and patients in advance, and coordinating travel logistics, with all mileage and travel expenses covered by the company.

• Assist with ACO quality reporting and performance improvement activities, including MSSP reporting requirements and payer-specific submissions.

• Collect, review, and abstract quality data from various sources, including EMR systems, claims data, provider outreach, payer portals, medical records, patient engagement workflows, and internal applications.

• Utilize multiple systems and applications to manage daily tasks on non-appointment days, including EMR platforms, payer and vendor portals, Guidehealth applications, Microsoft 365, 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.

• Utilize quality-related resources to ensure the accuracy and completeness of work, including NCQA/HEDIS®, CMS, MSSP measure specifications, coding guidance, project workflows, and quick-reference materials.

• Prioritize daily tasks to meet 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, when appropriate, with customers, providers, payers, and care teams.

• Adhere to established policies, procedures, and workflows to ensure compliance and quality performance across various payer programs.

• Collaborate with customers, payers, providers, care teams, and internal departments to foster quality performance improvement.

• Participate in departmental, payer-sponsored, and ACO-related training sessions, webinars, and support calls throughout the year.

• Build and maintain strong working relationships with co-workers, customers, providers, payers, and care teams.

• Complete training, orientation, and shadowing in the quality improvement department, progressively taking ownership of assigned customer or program responsibilities.

• Assist in preparing for customer meetings and over time assume lead or co-lead responsibilities for the quality improvement segments of those meetings.

• Perform additional duties as assigned to support quality improvement, reporting, patient outreach, and customer success.

⛳️ Requirements

• Willingness and ability to travel daily, up to 100%, to provider practices and patient homes to conduct scheduled eye exams; no prior experience with eye exams or imaging is necessary as complete training and equipment are provided by the company.

• A valid driver’s license and reliable transportation are required.

• An associate degree or higher in a related field is needed.

• At least 1–3 years of experience in a healthcare environment is necessary.

• A minimum of 2 years of experience supporting Medicare Advantage, Commercial, Medicaid, or MSSP quality programs, including data abstraction and patient outreach, is required.

• Experience with EMR systems, medical records, health data, chart review, or data abstraction workflows is essential.

• Familiarity with medical terminology, quality measures, medical billing, or coding is preferred.

• Proficiency in Microsoft Excel, PowerPoint, Word, Outlook, Teams, and various healthcare-related systems or applications is necessary.

• Strong verbal and written communication skills are essential.

• Attention to detail, organizational skills, and the ability to meet strict deadlines are crucial.

• Ability to collaborate effectively with management, co-workers, customers, providers, payers, and care teams is required.

• Capability to work independently in a remote setting is essential.

🏝️ Benefits

• Work from Home: Guidehealth is a fully remote organization, allowing you to minimize 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're well-covered.

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

• Have Peace of Mind: We provide Life and Disability insurance for those unexpected moments. We also offer voluntary Life options to ensure protection for 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 offer paid time off plans to help you achieve a healthy work-life balance and meet personal goals.

• Support Your New Family: Guidehealth provides paid parental leave to give you the necessary time with your family.

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