Clinical Quality Improvement Coordinator – Eye Exam Specialist

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

📋 Description

• Engaging in a field-based position that involves traveling to provider practices and patient residences for scheduled eye examination appointments, while virtually collaborating with team members, internal partners, customers, providers, payers, and care teams on non-appointment days.

• Acting as a subject matter expert on Medicare Advantage STAR, Commercial, Medicaid, and MSSP ACO quality measures, services, customers, and quality enhancement initiatives within commercial and governmental payer programs.

• Traveling to provider practices and patient homes as per appointment schedules to conduct diabetic eye exams (retinal screenings) utilizing company-provided imaging equipment and aiding in closing eye exam and related quality gaps.

• Performing proactive patient outreach on non-appointment days to identify and rectify quality gaps among Medicare Advantage, Commercial, Medicaid, and MSSP populations.

• Informing patients about preventive care practices, assisting in scheduling necessary screenings or appointments, and promoting adherence to treatment plans and medications to enhance health outcomes.

• Assisting with ACO quality reporting and performance improvement tasks, including MSSP reporting obligations and payer-specific submissions.

• Gathering, reviewing, and abstracting quality data from various sources, such as EMR systems, claims data, provider outreach, payer portals, medical records, patient engagement workflows, and internal applications.

• Conveying quality performance trends, hindrances, and improvement strategies internally and, when appropriate, with customers, providers, payers, and care teams.

⛳️ Requirements

• Willingness and capability to travel daily, up to 100%, to provider practices and patient homes for scheduled eye exams; no prior experience in eye exams or imaging is necessary, as comprehensive training and equipment are supplied by the company.

• Possession of a valid driver’s license and dependable transportation.

• An associate degree or higher in a relevant field.

• A minimum of 1–3 years of experience in a healthcare setting.

• At least 2 years of experience supporting Medicare Advantage, Commercial, Medicaid, or MSSP quality programs, which includes data abstraction and patient outreach.

• Familiarity with EMR systems, medical records, health data, chart review, or data abstraction processes.

• Understanding of medical terminology, quality measures, medical billing, or coding.

• Competency in using Microsoft Excel, PowerPoint, Word, Outlook, Teams, and various healthcare-related systems or applications.

• Excellent verbal and written communication skills.

• Strong attention to detail, organizational abilities, and capacity to meet stringent deadlines.

• Ability to collaborate effectively with management, colleagues, customers, providers, payers, and care teams.

• Capability to work independently in a remote setting.

🏝️ Benefits

• Work from Home: Guidehealth is a fully remote organization, offering 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 features a 3% employer match on your 6% contribution.

• Have Peace of Mind: We offer Life and Disability insurance for those unforeseen moments. Additionally, we provide voluntary Life options to ensure you and your loved ones are protected.

• 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 work-life balance and meet your personal objectives.

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

• Learn and Grow: Your professional development is a priority for us. Guidehealth offers a variety of resources dedicated to your learning and advancement within the organization.