Population Health Coordinator Job at Franciscan Health

Franciscan Health Michigan City, IN 46360

Michigan City Coolspring Health Center

1225 E Coolspring Ave Suite 1-A Michigan City, Indiana 46360

WHAT WE NEED
Care Coordinator

WHO WE ARE LOOKING FOR
Our health care professionals work together to deliver high quality care at the lowest possible cost. Continuous outreach and coordination of patient care is a critical part of making sure we continue to deliver care of uncompromising quality. Our Population Health Coordinator is an important part of this process coordinating care, reviewing daily patient details, and handling medical record management.

Are you independent and trustworthy? Do you have excellent communication skills? Can you coordinate multiple cases at the same time, giving each the proper attention? We need your skills.

WHAT YOU WILL DO
Conduct timely outreach to access current health status, implement interventions and make referrals to meet patient’s condition specific needs.
Assist with coordinating services as needed (e.g., durable medical equipment, Home Health, etc.).
Collaborate with CCC and PCP to promote implementation of evidence-based practice and provide appropriate frequency of monitoring and follow up.
Reinforce appropriate education, using a beneficiary and family-centered approach, to facilitate the achievement of health goals.
Assist with accessing appropriate resources to meet the patient’s needs.
Reinforce education, identifies gaps and makes appropriate referrals and facilitate coordination of care after collaboration with CCC and/or provider if appropriate to meet specific patient needs.
Modify outreach frequency in order to effectively monitor self- management to prevent adverse outcomes.
Utilize motivational interviewing and health-coaching techniques to engage beneficiary/patient and support system.
Comply with all required documentation for medical/legal reporting situations.
Complete documentation within policy-established timeframes.
Collaborate with health care team (e.g., physician, nurses, etc.) and elevate treatment plan and interventions.
Reassess and modify the plan as necessary to achieve health goals.
Identify and validate quality care gap when working with beneficiary/patient.
Run upcoming appointment reports for FPN providers to identify and validate care gaps and enter in appointment note to provider.
Outreach to beneficiaries/patient to close gaps in care i.e. fall risk screenings over the telephone or at office.
Discuss preventive screenings and quality gaps in care with beneficiary/patient to gain understanding and assist with scheduling tests or assessments to close gaps.
WHAT IT TAKES TO SUCCEED
Work autonomously and be accountable in a complex environment.
Adapt within an ever-changing healthcare environment.
Strong communication skills.
Knowledge of Medicare and commercial insurance.
Experience using Electronic Health Records (EHR).

TRAVEL IS REQUIRED:

Never or Rarely

COVID-19 VACCINATION

To further Franciscan Alliance's commitment to provide and maintain a safe and healthy workplace and prevent the spread of COVID-19 among our coworkers and their families; our patients, visitors, and vendors, and the community at large all Franciscan workforce members must be vaccinated, unless granted an exemption. We are committed to making the communities we serve healthier.

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.




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