Population Health Partner

Cityblock Health•Tampa, FL

4h•Remote

About The Position

The Population Health Partner (PHP) supports members with low medical complexity by helping them navigate health and social care resources. They assist in clarifying health-related priorities, connecting members to internal and external services, and triaging higher-level needs, including behavioral health concerns. The role focuses on addressing health-related social needs while also supporting care teams in securing medical, dental, and vision services, optimizing benefits, and ensuring members remain healthy at home. This is an entirely virtual role, requiring excellent organizational, communication, triage and data management experience, customer service skills, as well as proficiency using a range of technology platforms, and comfort working efficiently and effectively without.

Requirements

2+ years of relevant experience
High school degree
Excellent organizational skills
Excellent communication skills
Triage experience
Data management experience
Customer service skills
Proficiency using a range of technology platforms
Comfort working efficiently and effectively without direct supervision

Responsibilities

Member Engagement & Orientation – Receive members from engagement and care teams, explaining program expectations, duration, and goals, including care pathways and social needs.
Assessments & Intake – Complete assessments and screenings (including for behavioral health disorders) following protocols; collaborate with the RN Care Manager to determine appropriate program placement.
Care Planning & Goal Setting – Partner with the RN Care Manager to develop, refine, and adjust care plans based on member needs and quality improvement opportunities.
Care Coordination & Coaching – Support members in achieving and modifying care plan goals, focusing on risk mitigation, provider engagement, and addressing social needs.
Follow-Up & Member Support – Conduct ongoing check-ins to ensure progress on care plan goals, follow up on care coordination needs, and activate members around preventative care topics.
Referrals & Escalations – Identify emerging needs through screenings, refer members to appropriate care team resources, and support internal referral loop closure.
Operations & Documentation – Utilize Cityblock’s care facilitation, EHR, and scheduling platforms to document interactions, track tasks, and coordinate communication across teams.