Population Health Specialist, Population Health, Full Time, Day

The Population Health Specialist (PHS) will work in VHS ColigoCare/Population Health Department to provide individualized service, navigating, and supporting all provider practices within the clinically integrated network (CIN) to improve patient quality of care. The PHS will support all ColigoCare provider practices, including Valley Medical Group and Independent physicians, by developing and implementing processes designed to meet quality targets established by CMS and commercial payors. The PHS acts as an integral liaison between payors/insurers and the practices to analyze electronic quality reports and format these into actionable data at the practice level. The PHS facilitates this data-driven approach by conducting face-to-face visits at the practice site with office managers and/or providers to discuss opportunities for improvement. The PHS participates in providing educational seminars for practice managers and clinicians. The PHS regularly attends interactive meetings with commercial payors to better align our network with these payors and maximize our results in their shared savings programs. Under the direction of the Quality Supervisor, the PHS strives to influence behavior at the practice and provider levels to succeed in value-based care programs and improve the triple aim: improved quality, decreased cost of care, and improved patient experience.

Associates degree or higher preferred. In lieu of degree, 3+ years' experience in health- related field accepted.

Experience

Experience working with physician practices including provider education, practice management, or quality assurance preferred.

• Proficient in Microsoft Word and Excel; skilled in compiling and analyzing data.
• Knowledgeable in population health, utilization management, case/care management, healthcare contracts, and benefit eligibility.
• Strong critical thinking, problem-solving, decision-making, and time management abilities.
• Excellent oral and written communication skills; highly organized and adaptable.
• Self-starter with ability to multitask and support multiple professionals.
• Understanding of business fundamentals and cost management; committed to high-quality, cost-effective care.
• Exceptional interpersonal and customer service skills; able to respond promptly and professionally to customer needs.
• Maintains confidentiality and demonstrates courtesy, patience, and tact in all interactions.
• Team-oriented, fostering cooperative relationships and demonstrating respect, compassion, and professionalism.
• Skilled in influencing and motivating others; effective collaborator across all organizational levels.
• Demonstrates accountability, reliability, and commitment to organizational goals and behavioral standards.

Competencies

• Deliver population health management services aligned with ColigoCare goals and objectives.
• Use EMR systems, data warehouses, and insurer data to generate quality metric reports, identify care gaps, and track progress.
• Provide practices with insight and instruction for use of third-party applications that drive quality improvement, quality gap closure, and improved accuracy in coding.
• Coordinate and track digital and in person educational sessions that are aimed at improving documentation and diagnosis coding.
• Provide practices with reports on care gaps, monitor performance, and recommend process improvements.
• Document all patient-related activities accurately in EMR systems (Athena, Meditech, Health Endeavors, Qlik). Utilize the EMR to provide outreach for patients to meet preventative care and quality metric guidelines.
• Assist care teams in implementing best practices for preventive services and team-based care.
• Participate in meetings with insurers and internal teams to address quality metric gaps.
• Build strong relationships with physicians, care coordinators, and practice staff.
• Motivate and coach practices to adopt quality improvement strategies.
• Contribute to departmental improvement projects, workshops, and educational sessions.
• Maintain knowledge of quality metric standards to meet contract requirements and financial incentives.
• Enters updates and audits one's own API clocking transactions
• Perform other duties as needed to support patients, practices, and organizational goals.

Office setting; pleasant and well-lit department. Attendance at periodic internal and health plan specific meetings may be required. Occasional travel may be required, especially between practice locations. May have exposure to agitated, delirious, confused patients and/or family members exhibiting aggressive displays of threatening and/or violent behavior.