Population Health Manager

About the Role

The Population Health Manager provides professional social work services, care coordination, and population health support for the GENESIS program within the Office of Community Health Innovation (OCHI) at Roseman University of Health Sciences College of Medicine. This position assesses and addresses the psychosocial, behavioral, environmental, and social determinants of health impacting participating households and individuals. Working collaboratively with faculty, medical students, healthcare providers, community organizations, and interdisciplinary care teams, the Population Health Manager oversees the development and implementation care plans, provides case management and resource navigation services, coordinates referrals, advocates for vulnerable populations, and supports positive health and social outcomes for medically underserved communities. The role also serves as a subject matter expert in social determinants of health and supports student experiential learning through mentorship and community-based education.

Responsibilities

• Conduct comprehensive psychosocial and social determinants of health assessments; develop, implement, and monitor individualized care plans that address healthcare, behavioral health, and social service needs to improve household stability and outcomes.
• Coordinate day-to-day operations of population health and community outreach activities within the GENESIS program. In addition to weekdays, some household visits and outreach activities may be scheduled during the weekend.
• Coordinate care and services across healthcare, behavioral health, community, and social service systems; facilitate referrals, advocate for individuals and families, and reduce barriers to accessing resources and support services.
• Serve as a member of an interprofessional healthcare team providing health and social services in households within the GENESIS program, at the faculty practice group, Roseman Medical Group, as well as outreach for community partner sites.
• Assess and respond to complex social, behavioral, and environmental concerns through crisis intervention, supportive counseling, resource coordination, and family support services.
• Support implementation of population health and community outreach initiatives, develop collaborative partnerships, and promote equitable access to healthcare and community resources for underserved populations.
• Mentor and support medical students in household-centered care, social determinants of health, and community-based interventions while collaborating with faculty and interdisciplinary teams to enhance learning and care delivery.
• Maintain accurate case documentation, monitor outcomes and program metrics, support quality improvement and reporting activities, and ensure compliance with professional, ethical, regulatory, and confidentiality standards.

Qualifications

• Master of Social Work (MSW), Masters of Public Health (MPH) or Masters of Public Administration (MPA) from an accredited institution required.
• Minimum of three (3) years of experience in community outreach, social services, healthcare support, program coordination, or related field.
• Experience coordinating community-based programs, outreach activities preferred.
• Experience working with underserved populations preferred.
• Bilingual English/Spanish strongly preferred.

Knowledge, Skills, and Abilities

• Knowledge of social work theory, principles, ethics, and evidence-based interventions.
• Knowledge of social determinants of health, behavioral health systems, crisis intervention, and case management practices.
• Knowledge of healthcare systems, public assistance programs, housing resources, and community support services.
• Ability to conduct psychosocial assessments and develop comprehensive intervention and care plans.
• Ability to provide case management, care coordination, crisis intervention, and advocacy services.
• Strong interpersonal, communication, counseling, and conflict-resolution skills.
• Ability to work effectively with culturally diverse, underserved, and high-risk populations.
• Ability to analyze complex social and healthcare needs and develop appropriate intervention strategies.
• Ability to maintain accurate documentation and comply with professional, legal, and ethical standards.
• Ability to collaborate effectively within interdisciplinary healthcare and educational environments.
• Knowledge of trauma-informed, strengths-based, and culturally responsive practices.
• Ability to maintain confidentiality and exercise sound professional judgment.
• Proficiency with Microsoft Office Suite and ability to learn new systems and technology platforms.

Pay

$74,000 - $78,000