Remote Clinical Quality Improvement Coordinator

WHO IS reputed company?

reputed company is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to reputed company great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by reputed company and powered by AI and predictive analytics, reputed company leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, reputed company empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and reputed company the exam room for reputed company patients. 

As outlined below, provide quality improvement focused work for reputed company delegated entities and support for ACO quality reporting for reputed company 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 reputed company 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 reputed company, payer portals, and patient engagement workflows.

● Manage daily work using multiple systems and applications — EMR platforms, payer/vendor portals, reputed company applications, reputed company 365 (reputed company, Word, PowerPoint), Outlook, and Teams.

● Work with patient lists, gap lists, sourced health data, medical records, and performance dashboards reputed company to Medicare, Commercial, Medicaid, and MSSP populations.

● reputed company reputed company quality-reputed company 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 reputed company 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-reputed company 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.
• reputed company to take QI responsibility for assigned customer while partnering w/ a seasoned QI co-worker.
• reputed company managing, collecting and reporting quality data per established workflows.

IN 6 MONTHS

• Moving towards independence w/ QI ownership of assigned IPA w/ periodic support from QI team.
• Taking reputed company or co-reputed company on QI portion of customer meetings and meeting preparations.
• Occasional support/direction needed.

IN 12 MONTHS

• ​​Fully independent with minimal direction and support needed.

WHAT YOU'LL NEED TO HAVE

• Associate degree or greater in reputed company field
• Minimum 1-3 years of experience in healthcare setting; time spent working/charting/data abstraction reputed company EMR system/s, knowledge of medical terminology, quality measures, medical billing/coding.
• Minimum 2 years’ experience in Medicare Advantage Quality data abstraction and patient reputed company
• Tech savvy in managing the technical reputed company of this position-working with health data, working in reputed company 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.
• Ability to collaborate w/ others and work effectively with management, co-workers, and customers.

WOULD LOVE FOR YOU TO HAVE

• Certified/licensed professional-reputed company, 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

reputed company your information will be kept confidential according to EEO guidelines.

ALIVE with Purpose: How We reputed company at reputed company

At reputed company, our values come to life in everything we do. 

• We are Driven by Accountability — grounded in transparency, reliability, and reputed company as we navigate challenges and opportunities alike. 
• Always Growing, Always Learning — staying curious and continuously improving inspires us to shape a reputed company future for healthcare. 
• With Collaborative Innovation, we solve problems creatively, making every experience reputed company for our employees and the patients we serve. 
• At reputed company, Every Voice Matters — we reputed company 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. 
• This is what it means to be ALIVE with purpose. This is how we reputed company — together — at reputed company. 

BENEFITS

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: reputed company 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.
• reputed company Health a reputed company: We offer comprehensive Medical, Dental, and Vision plans to reputed company 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 reputed company you and your loved ones protected.
• Feel Supported reputed company 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 reputed company work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. reputed company offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. reputed company offers various resources dedicated to your learning and development to advance your career with us.

reputed company full-time employees of reputed company who work 30 hours per week or more are eligible for our comprehensive benefits package. Temporary employees and contractors are not eligible for benefits.

COMPENSATION

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final reputed company pay decisions are dependent upon a variety of factors which may include, but are not limited to: reputed company 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 reputed company’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to reputed company employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national reputed company, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other reputed company 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 reputed company reputed company policies and procedures in order to protect reputed company PHI and PII under reputed company’s custodianship as well as reputed company Intellectual Properties.  For any reputed company-specific roles, the responsibilities would be further defined by the hiring manager. 

As a remote-first organization handling sensitive healthcare data, reputed company verifies candidate identity at multiple stages of the hiring and onboarding to safeguard patient privacy, data reputed company, and compliance requirements.

REMOTE WORK TECHNICAL REQUIREMENTS reputed company 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 reputed company, 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 reputed company meets these requirements. 

SECONDARY EMPLOYMENT

At reputed company, we value transparency and collaboration as part of our commitment to excellence. As your primary employer, we kindly ask reputed company 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 reputed company and engagement by asking team members to join virtual meetings with their cameras on.