Population Health Manager

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 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 Upon Hire 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 - 25800 Northwestern Highway - Southfield 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. - 5:00 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, veteran status, or any other legally protected category. An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team. #J-18808-Ljbffr