Clinical Quality

4 weeks ago

Philippines CapitalMed Solutions Full time

Location Remote (Global – preference for candidates with U.S. healthcare experience) Employment Type Full-Time or Part-Time About CapitalMed Solutions CapitalMed Solutions is a U.S.-based healthcare support company providing end-to-end services in revenue cycle management, medical billing, credentialing, referral coordination, pre-authorization, chronic care management (CCM), and HEDIS quality measure support. We work with providers across the U.S. to help improve operational efficiency, compliance, and patient outcomes through data-driven clinical and administrative support. Position Overview We are seeking a Clinical Quality & Population Health Specialist to oversee quality measure performance and support value-based care initiatives for our client practices. This role involves coordinating Chronic Care Management (CCM) programs, assisting with HEDIS quality measures and MIPS reporting, and supporting operational workflows that close care gaps and improve outcomes across patient populations. Key Responsibilities Oversee and manage Chronic Care Management (CCM) processes including patient enrollment, outreach, and documentation Track and implement HEDIS quality measures and gap-closure initiatives across assigned client practices Support MIPS and other CMS quality reporting programs; assist in gathering and validating data for submission Review EMR data for accuracy and completeness; identify patients who meet or fail quality measure thresholds Collaborate with providers and practice managers to improve documentation and performance on value-based metrics Conduct chart audits and assist in abstracting data for quality reporting Support population health initiatives, preventive screenings, and care coordination efforts Develop dashboards, reports, or summaries for leadership and clients showing quality performance trends Educate staff and clients on compliance, coding, and documentation requirements related to CCM and quality measures Work closely with the operations and billing teams to ensure clinical and administrative alignment Qualifications Background in nursing, public health, health information management, or healthcare administration (RN, LPN, BSN, or equivalent experience preferred) 5+ years of experience in Chronic Care Management (CCM), HEDIS, MIPS, or population health programs Knowledge of quality metrics, care coordination, and risk adjustment (HCC/RAF) Experience with EHR/EMR systems (e.g., eClinicalWorks, Athenahealth, Epic, or similar) Excellent communication skills and attention to detail Strong understanding of payer quality programs and documentation requirements Tech-savvy, analytical, and comfortable using data to drive improvement Seniority level Mid-Senior level Employment type Full-time Job function Health Care Provider Industries Hospitals and Health Care #J-18808-Ljbffr

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