Population Health Coordinator

Mass General Brigham•Somerville, MA

1d•Hybrid

About The Position

The Population Health Coordinator (PHC) is an integral member of a data-driven Ambulatory Quality team that proactively seeks to optimize preventive and chronic disease care. Centrally based PHCs are assigned to support ambulatory practices and are expected to function as innovative and critical members of both their central team and practice-based teams. By gathering and organizing patient data, the Population Health Coordinator works to identify 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. PHCs facilitate high-value, patient-centered care that improves timely access to and provision of preventive services and chronic disease treatment.

Requirements

High School Diploma or equivalent required
Minimum of 2 years’ experience in customer service or in a health care setting.

Nice To Haves

Bachelor's Degree preferred
Experience in promoting healthcare behavior change is desirable
Proficiency in medical terminology and HEDIS quality performance knowledge preferred.
Prior use of electronic health records and other health care information systems desirable

Responsibilities

Gathers and manages quantitative and qualitative patient data using population registries and evidenced-based assessment tools
Learns and understands Primary Care practice workflows with respect to optimal and coordinated health care for target patient populations
Develops a keen understanding of primary care practice requirements
Manages patient data collection and generates reports for analysis
Conducts timely outreach tailored to meet each patient’s condition-specific needs
Support PHSO staff to develop creative processes to proactively manage target populations and provide data support and population health education when applicable
Provide data management, coordination, and patient outreach as needed for specific target patient populations
Recognize and report data inconsistencies to appropriate person
Contribute to the teamwork within and between departments.
Regularly attend and participate in meetings with coworkers and practice staff.
Provide constructive ideas, suggestions, and feedback in a positive manner.
Work 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
Attend practice and central team meetings as directed
Other duties as assigned