Job Description
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
● 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 outreach 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 outreach, payer portals, and patient engagement workflows.
● Manage daily work using multiple systems and applications — EMR platforms, payer/vendor portals, Guidehealth applications, Microsoft 365 (Excel, Word, PowerPoint), Outlook, and Teams.
● Work with patient lists, gap lists, sourced health data, medical records, and performance dashboards related to Medicare, Commercial, Medicaid, and MSSP populations.
● Leverage all quality-related 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 all 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-related 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
IN 6 MONTHS
IN 12 MONTHS
Qualifications
WHAT YOU'LL NEED TO HAVE
WOULD LOVE FOR YOU TO HAVE
Additional Information
All your information will be kept confidential according to EEO guidelines.
ALIVE with Purpose: How We Thrive at Guidehealth
At Guidehealth, our values come to life in everything we do.
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:
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.