Population Health Coord

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RESPONSIBILITIES:

• Tasked with leading population health initiatives including healthcare quality improvement activities for patients attributed to the Emory Healthcare Network (EHN) inclusive of the Emory Healthcare Primary Care Service Line.
• This includes direct patient engagement and coordination with primary care physicians (PCP) and practice administrative or clinical staff with the goal of improving the overall health of our patients.
• The work setting for the embedded Population Health Coordinator will be hybrid between the EHN office at Northlake and the primary care practice office(s) and may include the assignment of various locations.
• This position will report directly to their assigned Population Health Manager and the Director of Value-Based Performance Improvement.
• The embedded Population Health Coordinator job responsibilities will include but are not limited to: Direct patient engagement via pre-visit and post visit planning process (face to face telephonic EMR messaging etc.) to assist with coordination of health maintenance screenings/assessments directly related CMS/HEDIS quality measures and medication adherence measures by referral to EHC specialists other EHC healthcare facilities and RN Ambulatory Care Coordinators as needed to improve or maintain overall patient health. Coordinate with primary care office staff and/or providers to ensure appropriate referrals orders and tests are in place for the patient.
• This coordination should take place at an EHC facility to ease with transitions of care and to improve overall domestic network integrity.
• Monitoring / addressing medication adherence issues to ensure interaction with the PCP pharmacy and pharmacy benefit manager as needed and indicated by adherence reports.
• Performs chart audits within the Electronic Medical Record and abstracts medical record documentation labs screenings results etc. to identify compliant screenings for submission to health insurers (payers) and identify needed improvements/deficiencies in data capture that impact CMS Star measures through various payer portals.
• Performs chart audits within the Electronic Medical Record and identify chronic conditions/diagnoses that are present from previous visits but have not yet been recaptured during a recent office visit. Observance analysis improvement of all quality metrics data in various report formats that are identified on health plans contracted with the EHN.
• Development and implementation of population health improvement processes within the assigned practices to involve use of available data and EMR resources.
• Aggregation/analysis/presentation of all population health related data (quality measures) for assigned practices to identify and address performance trends and possible quality improvement activities.
• Provide weekly progress updates to assigned Population Health Manager and provider/practice admin.
• Coordinate quarterly performance meetings with providers/practice admin Population Health Manager and EHN Director of Value-Based Performance Improvement.
• Maintain current knowledge about relevant guidelines/specifications for all quality measures and population health management initiatives.

MINIMUM QUALIFICATIONS:

• Bachelors degree highly preferred.
• Two years of similar experience highly preferred.
• Outstanding interpersonal skills both telephonic and in person required.
• Basic computer skills including Microsoft Excel and Outlook required.
• Experience with EMR systems that includes data capture data mining and reporting within the EMR is required.
• Must be a true team player and self-starter.

Emory is an equal opportunity employer and qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcares Human Resources at . Please note that one weeks advance notice is preferred.