Population Health Care Coordinator

Essen Medical Associates

New York (NY)

On-site

USD 28,000 - 41,000

Part time

14 days+

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Job summary

Cirrus Health is seeking a Part-Time Care Coordinator to support Population Health initiatives, with a primary focus on Gaps in Care, patient outreach, quality measures, and care coordination. The Care Coordinator will work closely with healthcare providers, Office Managers, clinical teams, and population health leadership across Cirrus Health locations to identify and address outstanding care needs.

This individual will play an important role in improving quality outcomes, increasing patient

Qualifications

High school diploma or equivalent required; degree preferred.
Experience in care coordination and population health preferred.
Experience with Gaps in Care and quality measures preferred.
Familiarity with value-based care and preventive health programs is a plus.
Experience with EHR/EMR systems, eClinicalWorks (eCW) a plus.
Strong communication and patient engagement skills.
Ability to manage multiple priorities independently.
Knowledge of HIPAA and patient confidentiality requirements.

Responsibilities

Review patient populations to identify Gaps in Care and outstanding preventive or chronic care needs.
Conduct proactive patient outreach by phone and other approved methods to encourage completion of screenings, appointments, testing, and follow-up care.
Assist patients with scheduling appointments and navigating appropriate healthcare services.
Track outreach attempts, patient responses, appointments, and gap-closure activities within the appropriate systems.
Partner with providers and Office Managers to develop strategies for addressing outstanding quality and care gaps.
Support initiatives related to preventive care, chronic disease management, annual wellness visits, screenings, vaccinations, and other applicable quality measures.
Review patient records to confirm completion of services and ensure documentation for quality reporting.
Help identify barriers preventing patients from completing recommended care and coordinate with the appropriate team members to address those barriers.
Monitor assigned quality metrics and patient lists and provide updates regarding outreach and gap-closure progress.
Support value-based care and population health initiatives, including efforts focused on improving quality performance and patient outcomes.
Maintain accurate and timely documentation while protecting patient confidentiality and complying with HIPAA requirements.
Collaborate with providers, clinical staff, Office Managers, and Population Health teams across multiple Cirrus locations.
Perform additional population health and care coordination responsibilities as assigned.