Population Health Specialist

CommonSpirit Health•Lakewood, CO

About The Position

You have a purpose, unique talents and now is the time to embrace it, live it and put it to work. We value incredible people with incredible skills – but your commitment to a greater cause is something we value even more. This is the heartbeat of our organization and your time will be spent in a supportive, team environment with resources to help you flourish and leaders who care about your success. The Population Health Specialist uses knowledge of HEDIS quality metrics to complete documentation gap closures for payer programs by using data collected in patient’s electronic medical records and or submitted from clinics. Identifies care gaps and distributes information to team members who will work with patients to coordinate care. Proactively requests patient records when the need is discovered and updates patient’s electronic medical records as applicable. Ensures timely data submission of information to payers. Tracks and reports gap closures and participates in prayer meetings. Develops and maintains training materials for quality programs and assists with clinic trainings as directed. Manually conducts review of patients’ medical records seeking evidence/supporting documentation of care gap completion. Accurately updates medical records with new record information and or when data is found not to be in discreate data fields as trained. Through internal payer attestation processes, conducts manual care gap closures for records that have been completed and adequately documented. Provide support and or education to the utilization of network platforms or electronic health records where primary care practices can review quality and utilization performance and pull patient rosters and gaps of care. Facilitate practice improvement utilizing lean methodologies and best practices. Collects, tracks, reports, and communicates data and data analyses as required. Develops quality training materials that align with NCQA guidelines. Provide training to internal resources and clinics on payer quality measures and programs. Develops trusting, working relationships with primary care providers and support teams. Uses current healthcare research findings and other evidence to expand clinical knowledge, enhance role performance, and increase knowledge of professional issues. Uses quality measures to improve performance and accountability for patient outcomes, patient experiences and safe delivery of care. Use multiple payer platforms for data exchange and patient research. Collaborate with internal associates and payer resources to manage patient attribution in payer contracts. Participate in payer meetings to learn about contract performance and report work efforts to improve contract performance. Uses information technology to communicate, manage knowledge, mitigate error and support decision-making Through chart reviews and observation , identify opportunities to improve current processes and workflows that will enable providers and care teams to focus on care provision and to provide the highest quality care to patient populations. Assists in the development and execution of scalable, evidence-based strategies to improve quality performance across the network.

Requirements

High School Diploma or GED required
2-3 years healthcare experience in an outpatient medical practice preferred.
Proficient in use of computer applications, specifically Microsoft Office Products
Experience with electronic medical records preferred.
Experience with building training materials and training staff
1-2 years of experience with lean or six sigma methodologies
Experience with payer quality programs preferred.

Nice To Haves

Bachelor Degree (in healthcare) preferred

Responsibilities

Uses knowledge of HEDIS quality metrics to complete documentation gap closures for payer programs by using data collected in patient’s electronic medical records and or submitted from clinics.
Identifies care gaps and distributes information to team members who will work with patients to coordinate care.
Proactively requests patient records when the need is discovered and updates patient’s electronic medical records as applicable.
Ensures timely data submission of information to payers.
Tracks and reports gap closures and participates in prayer meetings.
Develops and maintains training materials for quality programs and assists with clinic trainings as directed.
Manually conducts review of patients’ medical records seeking evidence/supporting documentation of care gap completion.
Accurately updates medical records with new record information and or when data is found not to be in discreate data fields as trained.
Through internal payer attestation processes, conducts manual care gap closures for records that have been completed and adequately documented.
Provide support and or education to the utilization of network platforms or electronic health records where primary care practices can review quality and utilization performance and pull patient rosters and gaps of care.
Facilitate practice improvement utilizing lean methodologies and best practices.
Collects, tracks, reports, and communicates data and data analyses as required.
Develops quality training materials that align with NCQA guidelines.
Provide training to internal resources and clinics on payer quality measures and programs.
Develops trusting, working relationships with primary care providers and support teams.
Uses current healthcare research findings and other evidence to expand clinical knowledge, enhance role performance, and increase knowledge of professional issues.
Uses quality measures to improve performance and accountability for patient outcomes, patient experiences and safe delivery of care.
Use multiple payer platforms for data exchange and patient research.
Collaborate with internal associates and payer resources to manage patient attribution in payer contracts.
Participate in payer meetings to learn about contract performance and report work efforts to improve contract performance.
Uses information technology to communicate, manage knowledge, mitigate error and support decision-making
Through chart reviews and observation , identify opportunities to improve current processes and workflows that will enable providers and care teams to focus on care provision and to provide the highest quality care to patient populations.
Assists in the development and execution of scalable, evidence-based strategies to improve quality performance across the network.