Population Health Coordinator

High Country Community Health•Boone, NC

57d

About The 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.

Requirements

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

Nice To Haves

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.

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.