Population Health Coordinator

Description

Department: Quality Improvement

Immediate Supervisor Title: Director of Quality Improvement/ Risk Management (QI/RM)

Nature of Position:

This position is responsible for gathering and organizing patient data. The Population Health Coordinator works to identify patient's unmet needs, engage patients in their own care, gather summary information for treatment interventions, and enhance ongoing communication between the patient and her/his care team. This position collaborates with the Director of QI/RM and Chief Medical Officer (CMO) to ensure provider and patient needs are met.

Essential Job Responsibilities:

• Contacts our patients who have been identified as having unmet needs in their care.
• Empower and educate patients to have knowledge of screenings gaps.
• Encourages patients to schedule doctor visits to close these gaps with their PCP.
• Provides the information necessary to overcome concerns, fears and barriers that might be keeping the patient from closing their gaps in care.
• Makes appropriate appointments based on what gaps each patient needs closing based on QI reports.
• Follow appropriate scripts when calling patients about scheduling their appointment.
• Aid in the optimization of clinical workflows.
• Outreach in the community for patient engagement and community support.
• Look for possible grant opportunities that would assist the closing of gaps for our patient population and discuss with your supervisor how to obtain the grant funding.
• Other duties as assigned.

Requirements

Travel Requirements: Some travel is required for community outreach events, HCCH site visits, etc.

Education/Experience:

Required: Associate's degree, 1-2 years of experience, or a combination of education and experience.

Preferred: Experience with quality improvement programs, integration and informatics related to planning and population health management and involving:

Knowledge of NCQA recognition program PCMH, patient engagement surveys and EMR based reporting. Skill in interacting and communicating with patients, physicians and case managers.

Knowledge/Skills/Abilities:

• Knowledge of medical office/electronic health record software
• Excellent verbal communication skills
• Ability to be flexible and work with changing priorities in a fast-paced environment
• Requires excellent problem solving and critical thinking skills
• Must be able to interact with individuals of all cultures, education, and levels of authority
• Must be able to function as part of a team
• Basic medical terminology required

JOB FACTORS:

Physical Requirements: Requires extended periods of sitting. Some lifting less than 25 pounds. Must be able to work within and on a computer system for extended periods of time.