This position offers a fully remote opportunity to contribute to clinical quality improvement across multiple healthcare programs, including Medicare Advantage, Medicaid, Commercial plans, and MSSP ACOs. The coordinator will play a central role in advancing care quality by identifying gaps in patient care, supporting preventive health efforts, and ensuring accurate data collection and reporting.
Key Responsibilities
- Act as a subject matter expert on quality measures including NCQA/HEDIS®, CMS, and MSSP standards across payer programs.
- Conduct patient outreach to promote preventive care, close gaps in treatment, and support medication adherence.
- Extract and analyze clinical data from EMRs, claims systems, payer portals, and patient engagement tools.
- Support ACO reporting obligations and meet critical deadlines for STAR Ratings, Medicaid programs, and commercial payer requirements.
- Use performance dashboards and gap lists to monitor quality metrics and track progress.
- Collaborate with providers, payers, and internal teams to improve clinical outcomes and reporting accuracy.
- Follow established workflows and compliance protocols to ensure data integrity and regulatory alignment.
- Stay current with evolving guidelines by participating in required trainings, webinars, and support sessions.
Tools and Systems
The role requires regular use of EMR platforms, payer and vendor portals, Microsoft 365 applications (Excel, Word, PowerPoint, Outlook, Teams), and proprietary quality management systems. Strong organizational and digital navigation skills are essential for managing multiple data sources and workflows.
Collaboration and Communication
Effective communication is key. The coordinator will interact professionally with care teams, providers, and stakeholders to share performance insights, address barriers, and support continuous improvement. Building trust and clarity across virtual channels is a core part of the role.
