Population Health Specialist

spectrumhealth; Southfield (MI); On-site; USD 52,000 - 75,000; Full time

Job summary

Corewell Health Southfield Center is seeking a Population Health Specialist to drive outreach to patients with gaps in chronic disease management, leveraging the Medical Home model and EMR data to close gaps and improve care.

You will travel to ambulatory sites, collaborate with the Practice Transformation Team, generate reports, and support quality initiatives across clinics.

Qualifications

• High School Diploma or equivalent required.
• 2+ years of experience in a medical assistant role, or population health related role.
• Experience in data entry.

Responsibilities

• Provide outreach using the Medical Home model to identified patients.
• Validate gaps using EMR data, registries, and payer portals.
• Maintain tracking of outreach and gap closure.
• Initiate outreach via EMR portal messages, phone calls, and letters.
• Collaborate with Practice Transformation Team on quality care improvements.
• Prepare reports as needed.
• Travel to ambulatory sites for outreach and coordination.
• Conduct focused projects/audits as assigned.

Skills

Patient outreach

Data entry

Communication

Team collaboration

Travel flexibility

Education

High School Diploma or equivalent

Medical Assistant program (preferred)

Tools

EMR systems

Payer portals

Job description

Job Summary

The Population Health Specialist is responsible for outreach to patients with gaps in chronic disease management and preventive care. This role serves to support health status improvement through access to services, education, wellness support and reinforcing the importance of the patient/primary care provider relationship.

Essential Functions

• Utilizes the Medical Home model to provide targeted outreach to identified patients. Includes current and new patients.
• Utilizes EMR Systems, registries, health maintenance data, opportunity reports, payer portals and other data as available to validate gaps and conduct outreach activities as assigned.
• Maintains tracking of outreach and gap closure.
• Using EMR tools, initiates outreach via EMR portal messages, phone calls, and/or via letters.
• Updates EMR Systems and payer portals as appropriate.
• Supports supplemental data submission process for plans without electronic supplemental feeds.
• Collaborates with Practice Transformation Team on the identification of quality care improvements.
• Shares findings of identified concerns/issues/quality care improvements related to gap closure, ordering process and documentation of care with quality team so that they may be addressed and/or implemented efficiently and effectively.
• Prepares reports as needed.
• Collaborates with practice staff to provide additional information and coordination of practice level phone calls.
• Performs special focused projects/audits as assigned.
• Complete all scheduled eye exams at ambulatory clinics, updating portal information, and ensure practices receive results for all patients.
• Traveling to ambulatory sites.
• Investigation of community resources/assistance needed for patient population; ensure an agency guest and/or information is available monthly to support the development of the material provided to the clinics.
• Outreach to outside clinics and health systems for results and quality data needed for improvement of practice scores.
• Perform quarterly quality measure audits to ensure practices compliance with documentation requirements.

Qualifications

Required

• High School Diploma or equivalent
• 2 years of relevant experience and minimum of 2 years of experience as a medical assistant in a clinical physician practice, a clinical nursing program, or 2+ years of in a population health related role.
• Experience in data entry.

Preferred

• Completion of an accredited Medical Assistant program or LPN, EMT, ER Tech, or equivalent of education and relevant experience.
• CRT-Medical Assistant, Certified (CCMA) - NHA National Health career Association

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here . On-demand pay program powered by Payactiv Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! Optional identity theft protection, home and auto insurance Traditional and Roth retirement options with service contribution and match savings Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Corewell Health Southfield Center - 26901 Beaumont Blvd

Department Name

Arvon CIN - Corporate

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8:00 a.m. - 4:30 p.m.

Days Worked

Monday - Friday

Weekend Frequency

N/A

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, vetera