Remote Clinical Quality Improvement Coordinator

Guidehealth is a remote, data-powered healthcare company focused on improving outcomes and making high-quality care more affordable through technology and operational excellence.

The Remote Clinical Quality Improvement Coordinator supports delegated entity quality improvement work and ACO quality reporting across multiple payer programs, helping identify and close quality gaps through data abstraction, reporting, and patient outreach.

• Provide quality improvement (QI) support for delegated entities and assist with ACO quality reporting for contracted ACOs.
• Serve as an SME across Medicare Advantage STAR, Commercial, Medicaid, and MSSP ACO quality measures and related initiatives.
• Conduct proactive patient outreach to identify and address quality gaps; educate patients on preventive care, schedule screenings/appointments, and support adherence to treatment plans and medications.
• Support quality reporting and performance improvement activities, including MSSP reporting requirements and payer-specific submissions.
• Collect and abstract quality data from EMRs, claims, provider outreach, payer portals, and patient engagement workflows.
• Manage daily work across multiple systems (EMR platforms, portals, Guidehealth applications) and Microsoft 365 tools (Excel, Word, PowerPoint) plus Outlook/Teams.
• Work with patient/gap lists, sourced health data, medical records, and performance dashboards across Medicare, Commercial, Medicaid, and MSSP populations.
• Use measure specifications and reference resources (NCQA/HEDIS®, CMS, MSSP), coding guidance, and workflows to ensure accuracy and completeness.
• Prioritize work to meet deadlines for STAR Ratings, Medicaid quality programs, Commercial payer initiatives, and MSSP timelines.
• Communicate performance trends, barriers, and improvement strategies internally and with customers, providers, and payers.
• Follow established policies and procedures for compliance across payer programs and protect PHI/PII per security policies.
• Collaborate with customers, payers, providers, and internal teams; participate in trainings, webinars, and support calls.

• Associate degree or higher in a related field.
• 1–3 years of experience in a healthcare setting, including EMR charting/data abstraction; knowledge of medical terminology, quality measures, and medical billing/coding.
• At least 2 years of Medicare Advantage quality data abstraction and patient outreach experience.
• Strong technical skills: working with health data, navigating multiple systems/applications, and using Excel and PowerPoint.
• Excellent verbal and written communication skills.
• High attention to detail, strong organization, and ability to meet hard deadlines.
• Ability to collaborate effectively with management, coworkers, and customers.
• Preferred: CMA or LPN licensure/certification.
• Preferred: experience with payer-required QI initiatives and data submissions; quality database entry/reporting; interpreting and reporting quality information and training staff; proficiency with EMR software and cloud platforms.
• Remote work technical requirement: employee-provided internet capable of video calls; minimum 100 Mbps download and 10 Mbps upload.

• Fully remote role; daily virtual engagement with team and company.
• Equipment provided by Guidehealth at no cost; employee must provide qualifying home internet connection.
• Must be accessible during stated working hours and join virtual meetings with camera on.
• Comprehensive benefits for full-time employees working 30+ hours/week: medical, dental, vision; 401(k) with 3% employer match to 6% contribution; life and disability insurance (plus voluntary life options); Employee Assistance Program (EAP); paid time off; paid parental leave; learning and development resources.
• Identity verification occurs at multiple stages of hiring/onboarding due to handling sensitive healthcare data.
• Secondary employment must be disclosed.