Coordinator - The Longstreet Clinic - Population Health

Northeast Georgia Medical Center•Gainesville, GA

1d•Onsite

About The Position

The Population Health Coordinator is responsible for developing and monitoring care coordination processes and providing support to the population health team for the implementation of these processes. This role serves as a support to the Care Managers and as a liaison between the patient, family, and the healthcare delivery team, including inpatient facilities, emergency departments, and ancillary services.

Requirements

Certified Medical Assistant. In lieu of CMA, 5 years of direct population health experience is required.
High School Diploma or GED.
Ability to motivate people to participate in special programs.
Ability to effectively communicate with physician office staff.
Excellent interpersonal and customer service skills, including telephone etiquette.
Reading, Writing, Reasoning, Talking, Keyboarding.

Responsibilities

Reach out and engage patients to facilitate care delivery coordination, care gaps, and care needs; maintain daily call schedule.
Outreach to low-risk patients during care transitions.
Outreach to patients discharged from the ED.
Serve as a liaison between the patient, their family, and their Longstreet Clinic care team.
Assist in data collection, management, and patient outreach as needed for target patient populations.
Create a positive experience for patients and families through courteous interactions via phone, patient portal, and in-person, as well as appropriate and efficient routing and referrals to clinical staff or other practices when necessary.
Work with Care Managers on quality improvement and meeting requirements for achieving/maintaining NCQA practice and provider recognitions for (but not limited to) Patient-Centered Medical Home, Diabetes Recognition, and Heart/Stroke Care Recognition.
Work with Care Managers reporting quality and performance improvement initiatives; establish and monitor performance goals and improving overall patient care metrics.
Report to Population Health Manager on productivity goals and performance.
Participate in the development/review/revision of standard work and related policies and/or procedures for Care Manager services.
Attend and participate in regular meetings with the Population Health Team as well as within other departments (Clinical and Non-Clinical) and practices as needed.
Actively participate in required offsite health fairs and other community events as assigned.
Other duties as assigned/deemed necessary.