Job Description

The Clinical Quality Improvement Coordinator - Eye Exam Specialist is primarily responsible for performing scheduled diabetic eye exams (retinal screenings) for members at provider practices and patient homes, using imaging equipment supplied and trained on by the company. Travel to and from appointments is covered by the company. On days without scheduled eye exam appointments, this role supports the broader quality improvement initiatives across delegated entities and contracted Accountable Care Organizations (ACOs), including quality reporting, performance improvement, patient outreach, quality gap closure, and data abstraction activities across Medicare Advantage STAR, Commercial, Medicaid, and MSSP ACO quality programs.

This role also serves as a quality improvement resource for internal teams, customers, providers, payers, and care teams on non-appointment days. This includes working with multiple systems and data sources to identify quality gaps, support patient engagement, collect and validate quality data, and assist with payer-specific and ACO reporting requirements.

Success in this role requires comfort operating specialized retinal imaging equipment (full training and camera provided), strong attention to detail, willingness to travel daily to provider practices and patient homes for scheduled eye exam appointments, knowledge of healthcare quality measures, comfort working with health data and multiple systems, strong communication skills, and the ability to manage deadlines in a field/remote hybrid environment.

WHAT YOU'LL BE DOING

• This role will require up to 100% field travel in the Nashville, TN 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.

Qualifications

WHAT YOU'LL NEED FOR SUCCESS

• 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.

WHAT WE'D LOVE FOR YOU TO HAVE

• Certified or licensed healthcare professional credential, such as Certified Medical Assistant (CMA) or Licensed Practical Nurse (LPN).
• Experience with quality improvement initiatives and data submissions required by health insurance payers.
• Experience with Medicare Advantage STAR, Medicaid, Commercial, and/or MSSP ACO quality programs.
• Experience with NCQA/HEDIS®, CMS, MSSP, or payer-specific quality measure specifications.
• Experience with quality database entry, reporting, and performance dashboards.
• Experience interpreting and reporting quality information.
• Experience training staff or supporting provider/care team education related to quality initiatives.
• Proficiency with Electronic Medical Record (EMR) software, payer portals, vendor platforms, and cloud-based applications.

Additional Information

The salary range for this position is $60,000.00 to $64,000.00 per year.

ALIVE with Purpose: How We Thrive at Guidehealth

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

• We are Driven by A ccountability — grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike.
• Always Growing, Always L earning — staying curious and continuously improving inspires us to shape a better future for healthcare.
• With Collaborative I nnovation, we solve problems creatively, making every experience better for our employees and the patients we serve.
• At Guidehealth, Every V oice Matters — we believe our collective strength is rooted in the unique perspectives of each team member.
• And through E mpathy 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 thrive — together — at Guidehealth.

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: 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: Welcoming a new family member takes time and commitment. 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.

All full-time employees of Guidehealth 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 base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill 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 Guidehealth’s values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related 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 all Security policies and procedures in order to protect all PHI and PII under Guidehealth’s custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.

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

REMOTE WORK TECHNICAL REQUIREMENTS

Guidehealth 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 connection, 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 connection meets these requirements.

SECONDARY EMPLOYMENT

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