Guide Healthcare
51 - 200 employees
Founded 2018
⚕️ Healthcare Insurance
🏥 Healthcare
🎯 Recruiter
Healthcare Insurance • Healthcare • Recruitment
Guide Healthcare is leading a movement where creativity delivers positive change in the healthcare sector. The company specializes in allied health service provision and healthcare recruitment, focusing on the support and treatment of older adults. With a commitment to adding value to their clients, partners, and teams, Guide Healthcare aims to do things differently in the industry.
Clinical Quality Improvement Coordinator - Eye Exam Specialist
Job not on LinkedIn
🔥 1 hour ago
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Guide Healthcare
51 - 200 employees
Founded 2018
⚕️ Healthcare Insurance
🏥 Healthcare
🎯 Recruiter
Healthcare Insurance • Healthcare • Recruitment
Guide Healthcare is leading a movement where creativity delivers positive change in the healthcare sector. The company specializes in allied health service provision and healthcare recruitment, focusing on the support and treatment of older adults. With a commitment to adding value to their clients, partners, and teams, Guide Healthcare aims to do things differently in the industry.
📋 Description
• This role will require up to 100% field travel in the Philadelphia, PA area. • Qualified candidates must reside locally. • Working in a field-based role, traveling to provider practices and patient homes for scheduled eye exam appointments, while engaging virtually with team members, internal partners, customers, providers, payers, and care teams on non-appointment days. • Serving as a subject matter resource across Medicare Advantage STAR, Commercial, Medicaid, and MSSP ACO quality measures, services, customers, and quality improvement initiatives under commercial and governmental payer programs. • Traveling to provider practices and patient homes on a scheduled appointment basis to perform diabetic eye exams (retinal screenings) using company-provided imaging equipment and supporting the closure of eye exam and related quality gaps. • Completing company-provided training on retinal imaging equipment and eye exam procedures prior to conducting exams independently and maintaining competency through ongoing training as needed. • Conducting proactive patient outreach on days without scheduled eye exam appointments to identify and address quality gaps across Medicare Advantage, Commercial, Medicaid, and MSSP populations. • Educating patients on preventive care measures, assisting with scheduling necessary screenings or appointments, and supporting adherence to treatment plans and medications to improve health outcomes. • Managing a daily eye exam appointment schedule, confirming appointments with practices and patients in advance, and coordinating travel logistics, with all mileage and travel expenses associated with eye exam visits being covered by the company. • Supporting ACO quality reporting and performance improvement activities, including MSSP reporting requirements and payer-specific submissions. • Collecting, reviewing, and abstracting quality data using multiple data sources, including EMR systems, claims data, provider outreach, payer portals, medical records, patient engagement workflows, and internal applications. • Managing daily work on non-appointment days using multiple systems and applications, including EMR platforms, payer and vendor portals, Guidehealth applications, Microsoft 365, Outlook, and Teams. • Working with patient lists, gap lists, sourced health data, medical records, and performance dashboards related to Medicare, Commercial, Medicaid, and MSSP populations. • Using quality-related resources to support the accuracy and completeness of work, including NCQA/HEDIS®, CMS, MSSP measure specifications, coding guidance, project workflows, and quick-reference materials. • Prioritizing daily work to meet quality reporting deadlines, including STAR Ratings, Medicaid quality programs, Commercial payer initiatives, and MSSP ACO reporting timelines. • Communicating quality performance trends, barriers, and improvement strategies internally and, as appropriate, with customers, providers, payers, and care teams. • Following established policies, procedures, and workflows to support compliance and quality performance across multiple payer programs. • Collaborating with customers, payers, providers, care teams, and internal departments to support quality performance improvement. • Participating in departmental, payer-sponsored, and ACO-related trainings, webinars, and support calls throughout the year. • Building and maintaining strong working relationships with co-workers, customers, providers, payers, and care teams. • Completing quality improvement department training, orientation, and shadowing and progressively assuming ownership of assigned customer or program responsibilities. • Supporting customer meeting preparation and, over time, taking lead or co-lead responsibility for quality improvement portions of customer meetings. • Performing other duties as assigned to support quality improvement, reporting, patient outreach, and customer success.
🎯 Requirements
• Willingness and ability to travel daily, up to 100%, to provider practices and patient homes to perform scheduled eye exams; no prior eye exam or imaging experience required, as full training and equipment are provided by the company. • Must have a valid driver’s license and reliable transportation. • Associate degree or greater in a related field. • Minimum of 1–3 years of experience in a healthcare setting. • Minimum of 2 years of experience supporting Medicare Advantage, Commercial, Medicaid, or MSSP quality programs, including data abstraction and patient outreach. • Experience working with EMR systems, medical records, health data, chart review, or data abstraction workflows. • Knowledge of medical terminology, quality measures, medical billing, or coding. • Proficiency using Microsoft Excel, PowerPoint, Word, Outlook, Teams, and multiple healthcare-related systems or applications. • Strong verbal and written communication skills. • Strong attention to detail, organizational skills, and ability to meet hard deadlines. • Ability to collaborate effectively with management, co-workers, customers, providers, payers, and care teams. • Ability to work independently in a remote environment.
🏖️ Benefits
• Work from Home: Guidehealth 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. • Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep 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 keep you and your loved ones protected. • Feel Supported When 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 achieve work-life balance and meet your personal goals. • Support Your New Family: Guidehealth offers paid parental leave to give you the time you need. • Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.
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