Population Health Specialist
About The Position
The Population Health Specialist (PHS) works under the supervision of the Quality Manager and supports collaboration, communication, and care coordination across the health care team, including POD leaders, practices, clinicians, and hospital leadership. As a primary point of contact and integral team member, the PHS helps promote safe, high-quality, evidence-based care across the health care continuum and supports the achievement of quality incentives in global payment and managed care contracts. The role aims to improve patients’ health and well-being, meet contractual metrics, and maximize revenue in quality risk arrangements. The PHS communicates targets for medical expense trends and quality outcomes, then facilitates activities to meet those targets through analysis of quality, cost, and utilization reports. The role also helps the health care team implement systems and interventions that improve care and outcomes by identifying key performance drivers and implementing project plans to address them.
Requirements
- Bachelor’s degree.
- Medical Assistant certification or 3–5 years of related experience in a health care environment.
- Strong knowledge of and experience with HEDIS ambulatory quality measures.
- Ability to travel to offsite meetings at provider practices and hospitals.
- Strong knowledge of Microsoft Office applications, including Word, Excel, Access, and PowerPoint, and other web-based applications.
- Ability to produce complex documents, perform analysis, and maintain databases.
Nice To Haves
- Knowledge of process improvement initiatives such as LEAN or Six Sigma.
- Knowledge of electronic medical records, including eClinical Works, Athena, GE Centricity, or Epic.
Responsibilities
- Serve as a subject matter expert on HEDIS ambulatory quality measures and communicate relevant information to assigned hospitals, POD leaders, physician groups, and clinical teams participating in BILPN risk-arrangement quality programs.
- Support practices in managing chronic-disease patient registries, including required testing and medication management; promote pre-visit planning, reminders, day-of-visit processes, and follow-up tests and referrals.
- Work with practices and providers to develop campaigns addressing gaps in care, monitor compliance, and provide feedback and adjustments to support campaign success.
- Support process improvements to clinician and staff workflows by identifying barriers and recommending initiatives; audit performance, evaluate compliance and engagement, and communicate findings.
- Provide expertise, training, and ongoing support for quality measures, EHRs, and related clinical and technical systems used to collect and track measures.
- Review key analytic reports monthly, extract data from analytics tools and practice EHRs, and inform PODs, practices, and clinicians about current performance and improvement opportunities.
- Communicate between POD leaders, practices, clinicians, and BILPN leadership; escalate engagement, participation, or performance concerns to the Quality Manager and Medical Director as needed.
- Identify and communicate best-practice opportunities and participate in team decisions about data requirements for proactive management of the team’s patient panel.
- Participate as needed in payer audits concerning quality-measure numerator compliance and exclusions.
- Coordinate with the Quality Manager to track and share practice data on patient-experience improvement measures and performance.
Benefits
- Influenza vaccination is required as a condition of employment; no other benefits are specified.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
