Jobs at Guidehealth

Performs scheduled diabetic retinal screenings in patient homes and provider practices, conducts patient outreach, abstracts and validates quality data, supports ACO and payer quality reporting, and serves as a quality improvement resource across Medicare Advantage, Commercial, Medicaid, and MSSP programs.

Perform scheduled diabetic retinal screenings in provider offices and patient homes (up to 100% field travel). On non-appointment days, support quality improvement: data abstraction, gap closure, patient outreach, reporting, and collaboration with providers, payers, and care teams across Medicare Advantage, Commercial, Medicaid, and MSSP programs.

Perform field-based diabetic retinal screenings using company-provided imaging equipment and support quality improvement across Medicare Advantage, Commercial, Medicaid, and MSSP ACO programs. Duties include patient outreach, data abstraction from EMRs and payer portals, quality reporting, coordinating appointments and travel, educating patients, and collaborating with providers, payers, and internal teams to close quality gaps and meet reporting deadlines.

Perform scheduled diabetic retinal screenings in provider offices and patient homes, support quality improvement and reporting across Medicare Advantage, Medicaid, Commercial, and MSSP ACO programs, conduct patient outreach and data abstraction, manage schedules and travel, and coordinate with providers, payers, and internal teams to close quality gaps and meet reporting deadlines.

The Remote RN Case Manager enhances member care through outreach, assessments, documentation, and collaboration with healthcare providers to ensure effective patient outcomes.

Serve as primary contact for members and providers via inbound/outbound channels. Provide empathetic, HIPAA-compliant support, resolve benefits/claims issues, conduct enrollment and clinical outreach, document interactions, escalate clinical concerns, and meet outreach and quality targets within dialer-based workflows.

Lead and supervise clinical compliance auditors and specialists to ensure adherence to UM and PHM plans and MSA clinical requirements. Develop auditing guidelines, coordinate training, manage reporting to the IPA UM Committee, perform secondary reviews of denials, support internal/external audits, and drive continuous improvement and cross-functional collaboration.

Work remotely as a subject matter expert on quality improvement measures (NCQA/HEDIS) for commercial and governmental payers. Conduct patient outreach, abstract and validate quality data from EMR/claims/provider sources, manage multiple systems and reporting, prioritize deadlines, and communicate performance and improvement strategies with internal teams and customers.

Remote coordinator responsible for managing quality improvement (QI) measures and patient outreach to close care gaps. Collects and abstracts data from EMRs, claims, and provider outreach; manages multiple systems, ensures NCQA/HEDIS adherence, prioritizes reporting deadlines, communicates performance and improvement strategies, and collaborates with payers, providers, and internal teams.

Remote role managing quality improvement (QI) measures for commercial and government payers: perform patient outreach, abstract quality data from EMR/claims, manage lists and reporting, ensure NCQA/HEDIS compliance, prioritize work to meet reporting deadlines, communicate performance and improvement strategies, and collaborate with providers, payers, and internal teams.

Remote role managing Medicare Advantage quality measures: perform patient outreach, abstract quality data from EMR/claims, manage multiple systems (EMR, payer portals, Guidehealth apps), prioritize reporting deadlines, communicate performance and improvement strategies with payers, providers, and internal teams.

Provide remote nursing care management: build relationships, create personalized care plans addressing medical, behavioral, and social needs; coordinate care across providers and settings; educate and empower patients; perform advocacy and motivational interviewing; collaborate with interdisciplinary teams; use EMR systems and data for insights while maintaining regulatory compliance and patient privacy.

Provide remote (and occasional in-person) patient navigation and care coordination to connect high-risk patients with medical, behavioral health, and community resources, document in EHRs, support value-based care metrics, escalate clinical or social needs, and improve outcomes through outreach, education, and workflow-driven interventions.

Lead technical onboarding and integration of clinical and claims data, manage EMR/API/SFTP integrations, design data flows and documentation, perform data QA/validation, troubleshoot issues, and manage go-live and post-implementation support.

Own the end-to-end lifecycle for an in-house conversational automation product (Rose). Partner with clinical operations to prioritize use cases, manage projects from requirements to deployment, analyze performance data, ensure regulatory and clinical compliance, conduct call audits, drive adoption, and communicate status and risks to senior leadership.