COORDINATOR, POPULATION HEALTH

Decatur County Memorial Hospital•Greensburg, IN

About The Position

The Population Health Coordinator supports population health initiatives by coordinating care delivery, patient engagement, and data-driven interventions across targeted patient populations. The role focuses on identifying high-risk patients, facilitating enrollment in chronic care management and remote patient monitoring (RPM) programs, and ensuring timely follow-up through care coordination, education, and outreach. The coordinator monitors patient outcomes, addresses care gaps, supports transitions of care, and collaborates with providers, pharmacists, and community resources to improve quality and reduce avoidable utilization. This clinical and operational position requires strong clinical judgment, care management, and communication skills to strengthen care coordination and advance proactive, value-based population health strategies. The coordinator also educates, trains, and mentors team members on remote patient monitoring devices, related technology, and software platforms to support consistent workflows and successful program implementation. The role reports to the Executive Director, Practice Operations, supervises no positions, and requires occasional local travel among hospital departments, physician practices, clinic locations, affiliated facilities, and community sites. Travel may also be needed for meetings, training, professional development, organizational events, and patient-home visits. The position generally follows standard business hours, Monday through Friday, with occasional flexibility to meet patient, operational, training, or organizational needs. It is classified as exempt and salaried.

Requirements

Associate degree in nursing (ASN), Bachelor of Science in Nursing (BSN), graduation from an accredited paramedic program, or an associate or bachelor's degree in a clinical discipline, healthcare administration, or related field is preferred; relevant education, training, and experience may be considered in lieu of the preferred degree requirements.
Two to four years of experience in population health, care coordination, chronic disease management, remote patient monitoring, or a related healthcare setting is preferred.
Proficiency in Microsoft Office, email, and standard computer applications, with the ability to learn and effectively use required software systems.
Ability to use remote patient monitoring technology and support patients with device setup, software navigation, user education, and basic troubleshooting.
Willingness and ability to obtain and maintain certifications, licensure, or credentials required or preferred for the position, including Community Health Worker certification.
Ability to establish and maintain effective relationships with patients, families, providers, community partners, and interdisciplinary care teams.
Ability to communicate effectively with people from diverse backgrounds and with varying levels of health literacy.
Initiative, critical-thinking, and organizational skills, including the ability to independently manage multiple priorities.
Ability to adapt to changing technologies, workflows, patient needs, and organizational priorities.
Commitment to patient-centered care, chronic disease management, preventive health strategies, and improved population health outcomes.

Nice To Haves

Two to four years of experience in population health, care coordination, chronic disease management, remote patient monitoring, or a related healthcare setting.
Community Health Worker certification.

Responsibilities

Develop, implement, and support the ongoing growth of population health and a new remote patient monitoring program, including workflows, patient identification, enrollment, and integration into clinical operations.
Coordinate a proactive approach to identifying and managing patients with chronic conditions and patients at increased risk for adverse health outcomes.
Coach and educate patients and families to improve health literacy, engagement, and self-management of chronic conditions within scope of practice.
Assess patients’ clinical, social, and other health-related needs and coordinate resources to address care gaps.
Facilitate access to primary care, specialty providers, pharmacists, educators, and other clinical or community resources.
Serve as a primary point of contact and advocate for patients and families, coordinating communication among providers, care teams, payers, and community resources.
Monitor patient participation, outcomes, and care needs to identify opportunities for timely intervention and improved population health outcomes.
Assist patients with remote patient monitoring enrollment, device setup, software navigation, connectivity, basic troubleshooting, and continued program engagement.
Educate, train, and mentor team members on remote patient monitoring devices, related technology, and software platforms.
Perform other duties as assigned.