Population Health Manager

MyCare Health Center•Center Line, MI

76d

About The Position

The Population Health Manager will coordinate population health management where a patient's health and potential risks are considered within a population they are part of. They are responsible for the successful planning and execution of key strategic activities that will enable the advancement of high-performance value based care (VBC) operations, Managed Care Organization (MCO) collaboration, and VBC quality metrics. This position supervises the Community Health Workers (CHW) to ensure increased access to health services for patients through outreach, encouraging engagement, education, and peer support.

Requirements

Must demonstrate excellent interpersonal skills and team-building skills;
Must have excellent decision-making skills, and attention to detail is imperative;
Professional written, verbal and listening communication skills;
Excellent computer skills including expert knowledge of Microsoft Office suite including Excel and Outlook, and Electronic Health/Medical Records.
Database management proficiency required; data entry skills required;
High functioning stress management, time management, and critical thinking skills are necessary for success in this role;
Health care related degree required (Associates degree at minimum);
Licensed Practical Nurse (LPN) or Licensed Registered Nurse (RN) preferred;
Knowledge of managed care and value-based agreements;
Demonstrated knowledge of Population Health Management, Patient Centered Medical Home concepts (PCMH), UDS, and HEDIS preferred.
Minimum of two years of experience working with a multi-disciplinary team in a health care setting;
Prior experience working with diverse population groups;
Excellent verbal and written communication skills, attention to detail and high level of customer service skills;
Must be able to travel between sites as needed and as otherwise required;
CPR certification required

Nice To Haves

Federally Qualified Health Center experience preferred, but not required.
Licensed Practical Nurse (LPN) or Licensed Registered Nurse (RN) preferred;
Demonstrated knowledge of Population Health Management, Patient Centered Medical Home concepts (PCMH), UDS, and HEDIS preferred.

Responsibilities

Monitor the outcomes of all value-based payer programs and identify strategies to improve the level of compliance for the defined measures.
Utilizes clinical data for specific patient populations to identify gaps and develop strategies to mitigate gaps in care.
Identify patient needs to develop a plan of care as defined by measurable goals.
Provide appropriate patient education for identified patients and specific populations.
Link patients with community resources to facilitate referrals and respond to social service needs.
Supervise and oversee the day-to-day activities of CHWs, offering guidance and ensuring they have the resources and training necessary to implement evidence-based practices in their work.
Participates in Quality Improvement (QI) activities that include identifying clinical opportunities for improvement, including performing QI audits for compliance with collaborative measures.
Track progress on current quality improvement initiatives, collaborating with care teams to implement changes as needed. Provide resources and answer questions from staff related to quality improvement projects.
Under the direction of the Director of Quality and Compliance, monitors utilization and service quality through HEDIS quality measures, payer/provider agreements, patient satisfaction surveys and complaints.
Facilitate strategic relationships with Managed Care Organizations (MCOs) to optimize opportunities for quality incentives and cost containment utilizing programs, networks, and services.
Ensure that managed care organizations have accurate and up-to-date information regarding population management and sharing information. Manage and update external databases when necessary.
Assist with the preparation of data for required reporting including annual UDS and PCMH reporting.
Other duties as required.

Benefits

After 90 Days of Employment, benefits may vary based on employment status
Student loan forgiveness programs (based on position and available federal programs)
11 Paid Holidays Annually (1 floating)
Up to 160 hours of annual PTO (based on start date)
Affordable premiums for medical, dental, and vision insurance coverage for individuals and families
No cost life insurance coverage (additional coverage optional for a fee)
Long term disability insurance
401K and Roth 401k retirement plans with discretionary employer match
Flexible Spending Account (FSA)
Short term disability insurance (optional for a fee)
Employee Assistance Program (EAP)