Remote Clinical Quality Improvement Coordinator
2 days ago
Atlanta
Job DescriptionCompany Description WHO IS GUIDEHEALTH? 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. Job Description As outlined below, provide quality improvement focused work for all delegated entities and support for ACO quality reporting for all contracted ACOs. WHAT YOU’LL BE DOING ● Work in a fully remote environment and virtually engage with company and team in your daily work. ● Serve as a Subject Matter Expert (SME) across Medicare Advantage STAR, Commercial, Medicaid, and MSSP ACO quality measures, services, customers, and quality improvement initiatives under various commercial and governmental payers. ● Conduct proactive patient outreach initiatives to identify and address quality gaps across Medicare Advantage, Commercial, Medicaid, and MSSP populations, engaging patients to educate them on preventive care measures, schedule necessary screenings or appointments, and support adherence to treatment plans and medications to improve health outcomes. ● Support ACO quality reporting and performance improvement activities, including MSSP reporting requirements and payer-specific submissions. ● Collect and abstract quality data using multiple data sources including EMR systems, claims data, provider outreach, payer portals, and patient engagement workflows. ● Manage daily work using multiple systems and applications — EMR platforms, payer/vendor portals, Guidehealth applications, Microsoft 365 (Excel, Word, PowerPoint), 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. ● Leverage all quality-related resources to ensure accuracy and completeness of work — measure specifications (NCQA/HEDIS®, CMS, MSSP), coding guidance, project workflows, and quick-reference materials. ● Prioritize daily work to meet various 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 with customers, providers, and payers. ● Follow all established policies and procedures for QI workflows to ensure compliance and success across multiple payer programs. ● Collaborate with customers, payers, providers, and internal teams to drive quality performance improvement. ● Participate in departmental, payer-sponsored, and ACO-related trainings, webinars, and support calls throughout the year. ● Communicate professionally and build strong working relationships with co-workers, customers, providers, and care teams. WHAT SUCCESS LOOKS LIKE IN 3 MONTHS • Complete QI Department training, orientation and shadowing., • Have a solid understanding of QI department scope of work and assigned customer., • Begin to take QI responsibility for assigned customer while partnering w/ a seasoned QI co-worker., • Moving towards independence w/ QI ownership of assigned IPA w/ periodic support from QI team., • Taking lead or co-lead on QI portion of customer meetings and meeting preparations., • Fully independent with minimal direction and support needed. Qualifications WHAT YOU'LL NEED TO HAVE • Associate degree or greater in related field, • 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., • Certified/licensed professional-CMA, LPN, • 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 Additional Information All your information will be kept confidential according to EEO guidelines. ALIVE with Purpose: How We Thrive at Guidehealth 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. While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include: • Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs., • Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered., • Plan for the Future: Our 401(k) plan includes a 3% employer match to 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 keep you and your loved ones protected., • Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times., • Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals., • Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need. 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. OUR COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT Diversity, inclusion, and belonging are at the core of Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment. OUR COMITTMENT TO PROTECTION OF PATIENT AND COMPANY DATA This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager. As a remote-first organization handling sensitive healthcare data, Guidehealth verifies candidate identity at multiple stages of the hiring and onboarding to safeguard patient privacy, data security, and compliance requirements. REMOTE WORK TECHNICAL REQUIREMENTS Guidehealth is a fully remote company. We provide new employees with the 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. The required internet speed is a minimum of 100 mbps download, 10 mbps upload. Please run a speed test here to confirm your internet connection meets these requirements. SECONDARY EMPLOYMENT At Guidehealth, we value transparency and collaboration as part of our commitment to excellence. As your primary employer, 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.