Population Health Specialist

Northeast Georgia Health System•Gainesville, GA

About The Position

The Population Health Specialist contributes to the multi-disciplinary population health team approach by providing knowledge and experience to support performance in our value-based contracts. The Population Health Specialist works cross-functionally with others internally and externally to support data driven results, uses patient outreach, education and expertise to ensure success of care gap closure for ambulatory care through clinician and patient engagement.

Requirements

MA Certification or equivalent experience in healthcare.
High School Diploma or Equivalent.
5 years experience with quality metrics/HEDIS and 5 years experience in the healthcare industry.
Excellent communication (verbal and written) and presentation skills to provide outstanding, personalized customer service and to instill confidence and to advocate for patients; ability to explain required information to patients in a comprehensible manner.
Understanding of population health concepts related to quality metrics and value-based contracts, care gaps, Quality Improvement, Medicare Stars, HEDIS measures and patient medical needs.
Ability to develop strong, trusting relationships with leadership, physicians, pharmacists, and patients in the value-based programs.
Highly organized, work autonomously, self-motivated with the ability to adapt to various workspaces.
Self-direct through multitasking and prioritizing.
Proficient with Microsoft Office applications (Word, Excel, Outlook, PowerPoint).
Other professional skills and qualities: strong attention to detail, dependability, empathy, focus on quality, goal-oriented, ability to delegate and direct others, outstanding phone etiquette.
Must practice discretion and confidentiality as position deals with highly sensitive and private data.
Individual with a patient-first mindset, excellent problem solving and communication skills, who can thrive in an autonomous and evolving environment.

Nice To Haves

LPN preferred.
Associates preferred.

Responsibilities

Identifies and closes care gaps as part of quality incentives with value-based contracts with the goal of optimizing patient health and well being and meeting the goals of each contract.
Participates as a key member of the quality team to work with patients and providers to close gaps in care.
Participate in deep dives to identify patients who are high cost/high utilizers and provide outreach as directed.
Perform chart reviews and data mining to obtain test results, lab results, and medical documentation that will close gaps in care.
Participate in workflows to support care gap closure.
Utilize available databases, payer portals, and other data and analytic tools to close care gaps and submit data to the payers to fulfill goals.
Use data to identify opportunities for process improvement and develop strategies to improve patient outcomes.
Participate in the process to submit supplemental data to payers.
Conduct telephonic outreach to patients to close care gaps.
Schedule appointments with providers to address healthcare needs as needed.
Work in conjunction with matrix partners to communicate care gap needs and actions.
Document all patient data/actions/interactions in all appropriate areas as deemed necessary.
Build rapport with patients, providers and clinical staff to identify strengths and barriers, promoting exceptional patient care while working to achieve success at quality metrics.
Participate and contribute to scheduled quality and payer meetings.