Population Health Coordinator

About the role

Responsible for working with patients, providers, and sites to provide data coordination, outreach to patients with chronic illnesses such as diabetes, hypertension, asthma, or behavioral health conditions, arrangement of preventive health screenings, and provision of assistance arranging or coordinating necessary care.

Primary Responsibilities

• Contacts patients for the purpose of achieving established outreach program goals, including via telephone, email and/or direct mailings to stress the clinical importance of receiving recommended lab work and attending medical appointments
• At the request of a Clinician, may place lab orders and/or schedule appointments in the electronic medical record system
• Generates reports using Healthy Planet Registry in Epic EMR to identify patients who require additional labs and those overdue for labs
• Consults with clinicians to determine required population reports and/or patient lists for analysis and outreach
• Communicates and collaborates with OPH nurses and care coordination staff to optimize patient care and supports patient care plans by assisting with linkages to, coordination of, and monitoring identified service needs
• Attends and participates in site Roster Reviews and Tier II meetings, when appropriate
• Recognizes and reports data inconsistencies, gaps in performance, and opportunities to improve results to appropriate personnel
• Performs all job functions in compliance with applicable federal, state, local and company policies and procedures
• Complies with health and safety requirements and with regulatory agencies such as DPH
• Complies with established departmental policies, procedures, and objectives
• Enhances professional growth and development through educational programs, seminars, etc.
• Attends a variety of meetings, conferences, and seminars as required or directed
• Assists with coordination of external test results ensuring that data is entered into EMR
• Performs other similar and related duties as required or directed
• Regular, reliable and predictable attendance is required

Required Qualifications

• High School Diploma/GED

Preferred Qualifications

• Understanding of medical terminology
• 2+ years of experience working with an electronic medical records (EMR) system
• 2+ years of experience within a medical office setting

Soft Skills

• Ability to collaborate closely with managers and other staff
• Effective presentation skills
• Excellent individual problem-solving skills and flexibility
• Must be able to work independently and be self-directed
• Proficiency with electronic medical record systems preferred
• Proficiency with Microsoft Office: Excel, Word, Access, and PowerPoint required
• Proficient with data manipulation including the ability to develop spreadsheets, build data tables and extract data

Pay

The hourly pay for this role will range from $18.00 to $32.00 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, and certifications.