Remote Clinical Quality Improvement Specialist

Guidehealth

Dallas (TX)

On-site

USD 38,572 - 41,328

Full time

14 days+

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Benefits offered by this job

Fully remote work with flexible hours

Comprehensive medical, dental, and vis

401(k) plan with a 3% employer match

Life and disability insurance

Employee Assistance Program (EAP)

Paid time off and parental leave

Professional development resources

Job summary

Guidehealth is a data‑powered, performance‑driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve patient health, and restore the fulfillment of practicing medicine for providers.

An innovative, fully remote organization that values agility, cross‑functional collaboration, and continuous learning. The role focuses on quality improvement initiatives, data abstraction, and patient outreach within Medicare Advantage and other payer

Qualifications

Associate degree or greater in a related field or certified/licensed professional (CMA, LPN).
Minimum 1–3 years of experience in a healthcare setting, including charting and data abstraction via EMR systems, knowledge of medical terminology, quality measures, and medical billing/coding.
Minimum 2 years of experience in Medicare Advantage quality data abstraction and patient outreach.
Technical proficiency managing health data, Excel, PowerPoint, and navigating multiple systems and applications.
Highly skilled in verbal and written communication.
Strong attention to detail, organized, and able to meet hard deadlines.
Ability to collaborate effectively with management, co‑workers, and customers.

Responsibilities

Work in a fully remote environment and virtually engage with company and team in daily work.
Serve as Subject Matter Expert on the entire scope of QI measures, services, customers, and quality initiatives under various commercial and governmental payers.
Conduct proactive patient outreach initiatives to identify and address quality gaps, educating patients on preventive care, scheduling screenings, and facilitating adherence to treatment plans.
Collect quality data using EMR, claims, and provider outreach sources.
Manage daily work with multiple systems and applications, including EMR systems, payer portals, vendor platforms, Guidehealth applications, Microsoft 365 (Excel, Word, PowerPoint, Teams).
Work with patient lists, gap lists, sourced health data, and medical records in your daily tasks.
Leverage quality‑related resources to ensure accuracy and completeness of work, including NCQA/HEDIS specifications, coding documents, and quick reference guides.
Prioritize daily work to meet quality reporting deadlines and requirements.
Communicate quality performances, barriers, and improvement strategies internally and with customers.
Follow all established policies and procedures for QI workflows.
Collaborate with customers, payers, and co‑workers to accomplish daily work.
Participate in all departmental and payer‑sponsored webinars, trainings, and support calls throughout the year.
Communicate professionally and develop positive relationships with co‑workers, customers, providers, and provider support staff.