Population Health Specialist

Job Title

Job Description

Characteristics of the Work

Under general supervision, acts as a liaison between the medical personnel, the patient, and the insurance provider, with the task of removing both the physical and behavioral barriers that prevent patients from actively participating in their own healthcare.

Identifies opportunities to reduce gaps in care for patients of Family Health Centers (FHC), as well as ways to engage patients that are not actively seeking primary care services.

Examples of Duties

Reviews patient care plan data provided by patients' insurance companies. Schedules appointments for the patient with the patient's provider, for annual screenings, or for other in-house consultations for successful completion of the patient's care plan. Participates in Quality Improvement (QI) activities. Connects patients who have not received primary care services for treatment or prevention to an appropriate FHC care team. Ensures that patient data is entered into FHC's Electronic Health Record (EHR) system for follow up and accurate reporting. Provides outreach to patients by connecting them with their assigned medical provider so assigned annual screenings and treatment plans are completed. Counsels patients on recommended health screenings. Provides direction and education to FHC patients who are over-utilizing emergency room visits, and coordinates appointments with their primary care provider(s) for more efficient care. Alerts medical providers of patient diagnoses that need to be addressed for risk adjustments and care gaps during medical visits. Communicates with FHC patients who were discharged from hospitals to coordinate follow-up care. Communicates with all providers and members of the care team and documents care to minimize fragmented care. Adheres to standard precautions. Performs related work as required.

Minimum Requirements

Bachelor's Degree in Social Work, Public Health, or a closely related field. An equivalent combination of training and experience may be substituted, as determined applicable by Civil Service. Physical Requirements and Working Conditions Lifts and moves materials weighing up to 10 lbs. Spends extended periods of time sitting and reaching. Spends extended periods of time typing and reading computer screens. Responds to patient and FHC needs via the telephone, internet, fax, computer software and in person. Identifies and processes electronic and paper medical record documentation. Special Requirements Must be able to work extended hours, including mornings, evenings, and Saturdays, as necessary. Must provide own transportation to work at other FHC locations as needed.

Supplemental Information

An Equal Opportunity Employer Test Weights Training & Experience: 100% Clinic Locations and Hours: FHC - Portland 2215 Portland Avenue Louisville KY 40212 View phone number on click.appcast.io Monday - Thursday: 8:00am - 9:00pm Friday: 8:00am - 4:30pm Saturday: 8:00am - noon Sunday: Closed FHC - East Broadway 834 East Broadway Louisville KY 40204 Monday - Thursday: 8:00am - 9:00pm Friday: 8:00am - 4:30pm Saturday: 8:00 - 12:00pm Sunday: Closed FHC - Phoenix (Healthcare for the Homeless) 712 E Muhammad Ali Blvd Louisville KY 40202 Monday - Friday: 7:30am - 4:00pm Saturday - Sunday: Closed FHC - Iroquois 4100 Taylor Blvd Louisville KY 40215 Monday: 8:00am - 4:30pm Tuesday: 8:00am - 8:30pm Wednesday - Friday: 8:00am - 4:30pm Saturday - Sunday: Closed FHC - Fairdale 1000 Neighborhood Place Fairdale KY 40118 Monday - Friday: 8:00am - 4:30pm Thursdays: 8:00am - 8:30pm Saturday - Sunday: Closed FHC - Southwest 9702 Stonestreet Road, Suite 220 Louisville KY 40272 Monday - Wednesday: 8:00am - 4:30pm Thursday: 8:00am - 8:00pm Friday: 8:00am - 4:30pm Saturday - Sunday: Closed FHC - Americana 4805 Southside Drive Louisville KY 40214 Monday - Friday: 8:00am - 4:30pm Saturday - Sunday: Closed

Medical Dental Vision Group Term Life Supplemental Life Accidental Death & Dismemberment Sick Leave Vacation Holiday Pay Bereavement Leave Kentucky Retirement Systems 457 Deferred Comp Tuition Assistance