Remote Clinical Quality Improvement Coordinator

Guidehealth is a data-powered healthcare company focused on improving outcomes and making care more affordable through operational excellence and analytics. The Remote Clinical Quality Improvement Coordinator supports delegated entities and contracted ACOs by driving quality improvement work and ACO quality reporting across multiple payer programs. The role focuses on closing quality gaps through data abstraction, reporting, and proactive patient outreach in a fully remote environment.

• Provide quality improvement (QI) focused support for delegated entities and ACO quality reporting for contracted ACOs.

• Serve as a subject matter expert across Medicare Advantage STAR, Commercial, Medicaid, and MSSP ACO quality measures and 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 and tools including EMR platforms, payer/vendor portals, Guidehealth applications, and Microsoft 365 (Excel, Word, PowerPoint) plus Outlook and Teams.

• Work with patient lists, gap lists, medical records, sourced health data, and performance dashboards for Medicare, Commercial, Medicaid, and MSSP populations.

• Use measure specifications and guidance (NCQA/HEDIS, CMS, MSSP), coding guidance, workflows, and reference materials to ensure accurate and complete work.

• Prioritize and deliver work to meet deadlines for STAR Ratings, Medicaid quality programs, Commercial payer initiatives, and MSSP ACO reporting timelines.

• Communicate performance trends, barriers, and improvement strategies with internal teams and with customers, providers, and payers.

• Follow established QI policies and procedures to ensure compliance across payer programs and protect PHI/PII.

• Collaborate with customers, payers, providers, and internal teams; participate in trainings, webinars, and support calls; maintain professional relationships.

• Associate degree or higher in a related field.

• 1–3 years of experience in a healthcare setting, including charting/data abstraction using EMR systems and 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 proficiency navigating multiple systems and applications; ability to work with health data and use Excel and PowerPoint.

• Highly skilled verbal and written communication.

• Strong attention to detail, organization skills, and ability to meet hard deadlines.

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

• Preferred: CMA or LPN licensure/certification.

• Preferred: experience with payer quality improvement initiatives and required data submissions; quality database entry and reporting; interpreting/reporting quality information and training staff.

• Preferred: proficiency with EMR software and cloud platforms.

• Fully remote role; virtual engagement with team and company is expected.

• Employees must be accessible during stated working hours and join virtual meetings with cameras on.

• Guidehealth provides necessary work equipment at no cost; employee provides their own internet connection.

• Minimum internet speed requirement: 100 Mbps download and 10 Mbps upload.

• Benefits for eligible full-time employees (30+ hours/week) include medical/dental/vision, 401(k) with employer match, life and disability insurance, EAP, paid time off, paid parental leave, and learning/development resources.

• Candidate identity verification occurs at multiple stages to protect patient privacy and data security; role requires adherence to security policies to protect PHI/PII.

• Secondary employment must be disclosed.