Population Health Coach & Care Coordinator

ADP, Inc.; Huntington (WV); On-site; USD 22,000 - 24,000; Full time

Job summary

Valley Health seeks a Population Health Advocate at Highlawn in Huntington, WV. The role emphasizes educating patients, coordinating care, and managing population health through registries and disease management activities.

You will perform health coaching, work with primary care teams, collect clinical data for tracking, support NCQA accreditation efforts, and help patients adopt lasting healthy behaviors.

Qualifications

• High School Diploma or equivalent; degree in Medical Assisting or Nursing preferred.
• Working knowledge of Medicaid/Medicare, adult learning and behavior change principles, chronic illnesses, co-morbidities and disease management.
• Skills include excellent verbal and written communication skills, telephonic interviewing skills, computer skills, and prioritization and organizational skills.
• Must be able to prioritize and target interventions designed to support long term behavioral change within state licensure scope of practice requirements

Responsibilities

• Provide health-coaching and consultation services to patients, within state licensure scope of practice requirements.
• Collaborates with patients to establish goals and provides ongoing support to members such that they strive to make and sustain healthy lifestyle choices.
• Collaborates with primary care health center staff and provider as well as medical home and other healthcare professionals to obtain specific and current health information in regards to member’s plan of care.
• Reviews data from variety of sources to assist in identifying co‑morbid conditions, hospitalizations, prescriptions and other factors that could impact the health of the patient.
• Assists in care coordination which may include obtaining test and referral results and communication with various entities including but not limited to community organizations, health plans, health facilities and specialists.
• Proactively address patient needs through population health management.
• Creates and manages patient registries that include care considerations for chronic disease management and preventive care.
• Effectively communicates with all patients with specific attention to the vulnerable patient population.
• Document all activities as outlined in the Valley Health Policy Manual
• Assist the operations team in collecting clinical data for NCQA accreditation, meaningful use, and insurance-sponsored PCMH projects.
• Other duties as assigned.

Skills

Verbal communication

Written communication

Telephonic interviewing

Organizational skills

Behavior change

Education

High School Diploma

Medical Assisting/Nursing degree preferred

Tools

Electronic Health Records (EHR)

Job description

Valley Health seeks a Population Health Advocate at Highlawn in Huntington, WV. The role emphasizes educating patients, coordinating care, and managing population health through registries and disease management activities.

You will perform health coaching, work with primary care teams, collect clinical data for tracking, support NCQA accreditation efforts, and help patients adopt lasting healthy behaviors.