Partners Healthcare System Somerville , MA 02143
Posted 2 weeks ago
About Us
As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care, and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.
We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step.
Our employees use the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.
General Overview
The Population Health Management (PHM) team works with the health system and community partners to develop, implement, and manage value-based care strategies that improve patient outcomes and reduce the cost of care. Our goal is to make care more affordable while addressing the health needs of our patients and communities.
Our multi-disciplinary team is comprised of forward-thinking individuals who can reimagine care models that meet the needs of the communities we serve. When you join the PHM team, you become a part of a team that strives to reinvent how care is delivered.
The Population Health Coordinator (PHC) is an integral member of a data-driven Ambulatory Quality team that proactively seeks to optimize preventive and chronic disease care. Centrally based PHCs are assigned to support ambulatory practices and are expected to function as innovative and critical members of both their central team and practice-based teams.
By gathering and organizing patient data, the Population Health Coordinator works to identify patients' unmet needs, engage patients in their own care, gather summary information for treatment interventions, and enhance ongoing communication between the patient and her/his care team. PHCs facilitate high-value, patient-centered care that improves timely access to and provision of preventive services and chronic disease treatment.
Key Areas of Responsibility:
Gathers and manages quantitative and qualitative patient data using population registries and evidenced-based assessment tools
Learns and understands Primary Care practice workflows with respect to optimal and coordinated health care for target patient populations
Develops a keen understanding of primary care practice requirements
Manages patient data collection and generates reports for analysis
Conducts timely outreach tailored to meet each patient's condition-specific needs
Contributes to Quality Improvement and Process Design of Population Health efforts
Follows established communication protocols and informs clinical team and program leadership accordingly
Participates in improvement projects within Population Health programs
Principle Duties and Responsibilities:
Manage patient registries and provide the members of health care teams with the data required to meet the health needs of the practice
Support PHM staff to develop creative processes to proactively manage target populations and provide data support and population health education when applicable
Provide data management, coordination, and patient outreach as needed for
specific target patient populations
Respond to inquiries from designated practices in a timely manner
Assist in process mapping and development of workflows for population health management at each of the designated primary practices
Answer and/or research questions on problems the clinicians have identified
Recognize and report data inconsistencies to appropriate personnel
Help mentor new hires during the onboarding process and assist in cross coverage as needed
Contribute to the teamwork within and between departments. Regularly attend and participate in meetings with coworkers and practice staff. Provide constructive ideas, suggestions, and feedback in a positive manner. Work collaboratively with co-workers to effectively resolve issues that impact departmental or hospital operations
Perform all job functions in compliance with applicable federal, state, local and company policies and procedures
Attend practice and central team meetings as directed
Other duties as assigned
Quality Improvement and Process Design
Collaborates with care teams to establish culturally sensitive, population-based interventions and workflows to reconnect patients to care
Works closely with practice teams planning tests of change by participating in the planning, implementation and analysis of PDSA improvement cycles as appropriate
Monitors and corrects population registries under the direction of the Provider and the care teams within the practice
Other duties as assigned
Qualifications
Bachelor's degree preferred
Minimum of 2 years' experience in customer service or in a health care setting. Experience in promoting healthcare behavior change is desirable
Proficient in data management and reporting
Proven problem-solver with ability to multi-task
Prior use of electronic health records and other health care information systems desirable
Skills, Abilities and Competencies
Strategic problem solving: Able to take initiative to solve problems and resolve issues; is resourceful in finding required data and recommending solutions.
Interpersonal/communication: strong interpersonal skills, including customer service orientation. The ability to interact with faculty, Medical Directors, senior Department leadership, trainees, and others in a knowledgeable, confident and professional manner.
Attention to detail: Commitment to accuracy and integrity of all data, reports, and communications.
Discretion and confidentiality: Ability to handle sensitive and confidential matters discreetly; ability to skillfully handle issues of sensitive nature with respect to confidentiality.
Organization. Exceptional organizational skills and ability to prioritize effectively, asking for direction when appropriate.
Capable of working cross-functionally. Ability to thrive and lead in a highly matrixed, collaborative, team-oriented environment. Ability to build consensus through negotiation and diplomacy and get work done through others
Communication. Comfortable interacting with senior leaders and facilitating teams of clinical leaders and senior managers
Flexibility. Flexible and adaptable within a complex, multi-site environment with changing requirements
Working Conditions
Split of office and remote working setting
Job responsibilities include heavy computer work and occasional work outside of regular business hours.
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