Clinical Care Coordinator; Population Health Job New York New York USA,Healthcare

Job Type: Officer of Administration
Hours Per Week: 35
Standard

Work Schedule:

Monday-Friday
Building: 3 Columbus Circle, New York, NY 10019
Salary Range: $115,000-$121,000

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to departmental budgets, qualifications, experience, education, licenses, specialty, and training. The above hiring range represents the University's good faith and reasonable estimate of the range of possible compensation at the time of posting.

Position Summary

Working in collaboration with the Population Health team, the Clinical Care Coordinator (Population Health) is responsible for coordinating and integrating high-quality, cost-effective care delivered to patients across an episode of illness or throughout the entire continuum of health care delivery. The Clinical Care Coordinator (Population Health) will adopt Columbia Doctors’ care coordination process and workflow to achieve improved health outcomes for populations.

Responsibilities
Care Management – 50%

Develop detailed care plans for patients based on the assessment of the patient's condition, clinical needs, social support, and barriers.
Act as a liaison between patients, caregivers, and health care and social services to improve overall health and social outcomes.
Document in patients' medical records and other data systems to ensure effective data collection and evaluation according to Columbia Doctor’s Care Coordination and Management Standards.
Conduct comprehensive post-discharge assessments for hospitalized patients and provide interventions to reduce complications and readmissions.
Provide education on disease process, medications, and self-management methods to patients and/or their caregivers with high clinical acuity and in consideration of barriers to care.
Outreach to patients who frequent the Emergency Room for avoidable visits, provide additional self-management support, and educate them on alternatives such as same-day physician appointments and urgent care facilities.

Operations – 20%

Support programs and/or initiatives with the goal of reducing complications and/or readmissions for the designated patient population.
Perform chart reviews at all assigned sites/practices to identify and close gaps in care as needed. Including, but not limited to, communication of findings to providers.
Increase overall compliance with medical appointments and routine screenings and improve medication adherence.
As part of the population health team, utilize data and tools to implement initiatives to achieve the reduction of inappropriate utilization of services such as avoidable ER visits, duplicate tests or procedures, risk identification, and decrease avoidable readmission rates.
Contribute to preventative health and chronic disease outcome improvement interventions such as newsletter articles, CAP IPA member education, and outreach, surveys, etc.
Performs all other duties and participates in debriefing and quality improvement initiatives as directed.

Strategy – 20%

Ensures care management programs are aligned with unit strategy and framework: improving the patient’s experience of care (including quality and satisfaction), improving the health of populations, and reducing costs as appropriate.
Collaborates with internal and external teams to develop plans and strategies to improve population health (e.g., close gaps in care, decrease healthcare costs, and improve the patient experience).
Utilizes tools and strategies for effective communication, including informal and formal presentations for internal and external audiences.

People – 5%

Promotes staff professionalism and performance with coaching, training, and feedback. Mentors others in individual and team…