Population Health Associate

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The Population Health Associate functions to support population management activities in the Division practices. The Population Health Associate collaborates with the Population Health Coordinator and the entire Care Team to help coordinate population health-related services with the goal of achieving positive health outcomes. Job responsibilities include using reports to identify patients who need periodic follow-up for gaps in care, lapses in care, and condition specific periodic testing/screening.

Job responsibilities also include making in-person, telephonic, or electronic outreach to identified patients to facilitate the implementation of identified health interventions. Scheduling appointments is a major function of this role.

• The Population Health Associate uses reports to identify patients who need health related services and testing, including patients with the following
• Gaps in Care: patients who are due for age appropriate screening tests including those on the Health Maintenance Tab and those identified by insurers
• Lapses in Care: patients with targeted chronic diseases (for example diabetes) who are overdue for periodic testing related to their chronic condition including those identified on the Health Maintenance Tab and those identified by insurers
• Condition specific periodic testing: patient with specific clinical conditions that require periodic testing to monitor (for example abnormal PAP smears, lung nodules)
• The Population Health Associate will need to be comfortable using reports from a variety of sources including those generated by insurers, ambulatory analytics , Montage, and others

• The Population Health Associate will connect with patients with gaps in care, lapses in care or in need of their periodic testing and facilitate scheduling of needed tests.
• The Population Health Associate will also connect with patients to gauge completion of specific health interventions such as completion of appointments, and other recommended follow-up activities.
• Population Health Associate will connect with patients will respond to patient questions or concerns by telephonic or other methods of communication (MPM, etc.)
• The Population Health Associate will schedule appointments, which is a major function of this role.

• The Population Health Associate will document in the specified platforms including Penn Chart and Red Cap following established workflows and processes
• Performs duties in accordance with Penn Medicine and entity values, policies, and procedures
• Other duties as assigned to support the unit, department, entity, and health system organization

• H.S. Diploma/GED (Required)
• 1+ years of experience in a health care setting (hospital, long-term care, homecare , physician practice, insurance, or social service) (Required)
• Associate's Degree or Bachelors Degree (Preferred)

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