Population Health Coordinator

Silver Pine Medical Group•Shelby Charter Township, MI

69d

About The Position

The Population Health Coordinator supports the development of patient-centered, team-based care. S/he will support primary care physicians (PCPs) and practices in managing their panel of patients. By organizing patient data, the Quality Coordinator works to capture patients’ 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. The Quality Coordinator is responsible for supporting quality improvement efforts as defined by the various health insurance companies and patient population. The Quality Coordinator will serve as a facilitator and catalyst for improving the clinical and operational performance using the Patient Centered Medical Home (PCMH) model of care within the practice. Clinical duties may include recording/updating medical record documentation and medical histories. Preparing patients for specific screenings based on chronic conditions and preventative health maintenance requirements. Ordering specific screenings and tests based on patient health and as recommended by physician champions.

Requirements

High School Graduate or GED
Minimum two years’ experience in a healthcare setting
Strong knowledge of medical terminology
Demonstrated computer skills for documenting patient care services in a health plan database
Ability to communicate effectively in person, on the telephone, and in writing
Ability to work independently and as a team
Strong ability to multitask in a busy primary care office setting
Ability to read and comprehend patient medical charts and medical terminology

Nice To Haves

Medical Assistant Certificate preferred
Strong knowledge of existing Healthcare Effectiveness Data and Information Set (HEDIS) and quality measures preferred

Responsibilities

Develops a keen understanding of primary care practice requirements for optimal, coordinated population health
Contributes to quality improvement and care redesign of population health efforts
Review patient’s medical charts for required services and quality opportunities
Enter required date of service data into various health plan databases
Contact patients regarding needed services and clearly communicate the importance of various services
Collaborate with care teams to establish population-appropriate, pre-visit, and point of care processes
Perform outreach functions, as necessary, to patients identified as having chronic conditions for needed services
Review reports as generated by the various insurance companies for areas of opportunity and improvement
Monitor and correct patient attribution to the practice and the care teams within the practice
Support practice staff to develop creative processes to proactively manage target populations
Provide data integrity, coordination, and patient outreach as needed for specific target patient populations
Contributes to a positive experience for patients and families through courteous telephone interactions as well as referral to appropriate clinical staff when necessary
Answer and/or research questions on problems the clinicians have identified
Recognize and report data inconsistencies to appropriate personnel
Contributes to the teamwork within and between departments. Regularly attends and participates in meetings with coworkers and practice staff. Provides constructive ideas, suggestions and feedback in a positive manner. Works collaboratively with co-workers to effectively resolve issues that impact departmental or hospital operations
Perform all job functions in compliance with applicable federal, state, local and company policies and procedures
And other duties as assigned