Remote Clinical Quality Improvement Coordinator

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

• Working in a fully remote environment and virtually engage with company and team in your daily work.
• Subject Matter Expert (SME) on entire scope of Medicare Advantage STAR measures, services, customers and quality initiatives under various commercial and governmental payers.
• Conducting proactive patient outreach initiatives to identify and address quality gaps, engaging with patients to educate them on preventive care measures, schedule necessary screenings or appointments, and facilitate adherence to treatment plans and medications, thereby contributing to improved health outcomes and closing quality gaps
• Collecting quality data using various methods of data sourcing-EMR, claims, provider / patient outreach.
• Managing daily work using multiple systems and applications-EMR systems, payer portals, vendor platforms, Guidehealth applications, Microsoft 365 for Excel, Word and PowerPoint, Microsoft Outlook and Teams for messaging and meetings.
• Working with patient lists, gap lists, sourced health data and medical records in your daily work.
• Leveraging all quality related resources to ensure accuracy and completeness of work-measure/project instructions, NCQA/HEDIS® specifications, coding documents, quick reference guides.
• Prioritizing daily work to meet various quality reporting deadlines and requirements.
• Communicating quality performances, barriers and improvement strategies both internally and with customers.
• Following all established policies and procedures for various QI workflows to ensure overall success.
• Collaborating w/ customers, payers, co-workers to accomplish daily work.
• Participating in all departmental and payer sponsored webinars/trainings/support calls throughout the year.
• Communicating professionally and develop positive relationships with co-workers, customers, providers and providers’ support staff.