Population Health Coordinator

METROPOLITAN PEDIATRICS LLC•Portland, OR

4d•$26 - $32•Onsite

About The Position

The Population Health Coordinator proactively tracks patient care needs and helps ensure patients receive services that optimize their health and well-being. The role oversees and promotes quality improvement related to care processes and payer metrics. Responsibilities may include engaging patients and families directly, tracking and closing gaps in care, maintaining accurate patient panels, coordinating with health plans, and combining data from multiple sources to provide an accurate picture of population-level quality of care. The coordinator leads population management by monitoring and sharing patient and population quality data throughout the organization, supporting improvement in care outcomes, and promoting proactive care for the entire patient population. The role serves as a subject matter expert on organizational quality metrics and participates in clinic medical home teams and quality improvement activities. It also involves outreach to patients and families, identifying barriers to care, maintaining clinic database provider panels, supporting clinical champions with timely data, and helping optimize capitation and quality payment programs. The coordinator maintains patient confidentiality, participates in clinic initiatives and meetings, provides workflow training as needed, and works dependably and effectively in a fast-paced, changing team environment.

Requirements

College degree or equivalent.
At least 3 years of experience in a clinical or public health setting.
Experience with electronic medical records (EMR).
Understanding of Patient-Centered Primary Care Home (PCPCH) requirements.
Knowledge and understanding of medical terminology and clinical procedures.
At least 3 years of experience in customer service, computers, general office procedures, multitasking, and understanding insurance terms.

Nice To Haves

Master’s degree in public health or another clinically related field.
Experience with panel management and quality metrics.
Experience with EPIC.

Responsibilities

Lead population management by monitoring and sharing patient and population quality data throughout the organization to facilitate improvement in care outcomes.
Promote proactive care for the entire population of patients connected with Metropolitan Pediatrics, including patients who do not come in for visits.
Serve as the subject matter expert for organizational quality metrics.
Participate as an active member of clinic medical home teams.
Support and lead quality improvement activities using knowledge of QI methodologies, relationships with managers and providers, and knowledge of goals and benchmarks.
Proactively contact patients and families identified as needing health maintenance or other care, individually or through monitoring and maintaining automated programs and workflows.
Conduct routine outreach by phone and through scheduled or unscheduled face-to-face meetings before, during, and after appointments, and direct PAS outreach activities to close gaps and meet goals.
Identify and reduce the impact of barriers that interfere with patients’ access to health care.
Maintain the provider panel section of the clinic database.
Partner with clinical champions to provide timely and accurate data for quality improvement efforts.
Maintain accurate provider panel lists, onboard newly assigned patients in a timely manner, and work with health plans and families to move incorrectly assigned patients to the appropriate medical home.
Escalate concerns identified through regular tracking to help maintain performance in metric, capitation, and quality payment programs.
Maintain confidentiality of sensitive patient information.
Participate in ongoing site-specific and clinic-wide initiatives.
Provide workflow training to other staff members as needed on population health and metric goals.
Attend and actively participate in huddles and team meetings.
Maintain high standards of office conduct and work effectively with others in a team setting.
Maintain punctual, regular, timely, and dependable attendance.
Work effectively in a fast-paced, changing environment, managing time and multitasking and prioritizing workload.