Population Health Specialist

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.

• 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.

• 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.

• 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.

• 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.

An Equal Opportunity Employer

Training &

Experience:

100%

www.fhclouisville.org

2215 Portland Avenue

Louisville KY 40212

Monday
- Thursday: 8:00am- 9:00pm

Friday: 8:00am- 4:30pm

Saturday: 8:00am- noon

Sunday:
Closed

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Monday
- Thursday: 8:00am- 9:00pm

Friday: 8:00am- 4:30pm

Saturday: 8:00 - 12:00pm

Sunday:
Closed

712 E Muhammad Ali Blvd

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Monday
- Friday: 7:30am- 4:00pm

Saturday
- Sunday:
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4100 Taylor Blvd

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Monday: 8:00am- 4:30pm

Tuesday:8:00am- 8:30pm

Wednesday
- Friday: 8:00am- 4:30pm

Saturday
- Sunday:
Closed

1000 Neighborhood Place

FairdaleKY 40118

Monday
- Friday: 8:00am- 4:30pm

Thursdays: 8:00am- 8:30pm

Saturday
- Sunday:
Closed

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

4805 Southside Drive

Louisville KY 40214

Monday
- Friday:8:00am- 4:30pm

Saturday
- Sunday:
Closed