Coordinator - The Longstreet Clinic - Population Health

Job Category:

Work Shift/Schedule:

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary

The Population Health Coordinator is responsible for developing and monitoring care coordination process and to provide support to the population health team for implementation of processes. The Population Health Coordinator will serve as a support role to the Care Managers as well as a liaison between the patient, family, and healthcare delivery team including inpatient facilities , emergency departments, and ancillary services.

Minimum Job Qualifications

• Licensure or other certifications: Certified Medical Assistant. In lieu of CMA, 5 years of direct population health experience is required.

• Educational Requirements: High School Diploma or GED.

• Minimum Experience:

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications:

• Preferred Educational Requirements:

• Preferred Experience:

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Ability to motivate people to participate in special programs 

• Ability to effectively communicate with physician office staff 

• Excellent interpersonal and customer service skills, including telephone etiquette 

​Essential Tasks and Responsibilities

• Reach out and engage patients to facilitate care delivery coordination, care gaps, care needs; maintain daily call schedule

• Outreach to low-risk patients during care transitions

• Outreach to patients discharged from ED

• Serving as a liaison between the patient, their family and their Longstreet Clinic care team

• Assisting in data collection, management, and patient outreach as needed for target patient populations

• Creating a positive experience for patients and families through courteous interactions via phone, patient portal and in-person, as well as appropriate and efficient routing and referrals to clinical staff or other practices when necessary

• Work with Care Managers on quality improvement and meeting requirements for achieving/maintaining NCQA practice and provider recognitions for (but not limited to) Patient-Centered Medical Home, Diabetes Recognition and Heart/Stroke Care Recognition

• Work with Care Mangers reporting quality and performance improvement initiatives; establish and monitor performance goals goals and improving overall patient care metrics

• Reporting to Population Health Manager productivity goals and performance

• Participates in the development/review/revision of standard work and related policies and/or procedures for Care Manager services.

• Attending and participating in regular meetings with the Population Health Team as well as within other departments (Clinical and Non-Clinical) and practices as needed

• Actively participates in required offsite health fairs and other community events as assigned

• Other duties as assigned/deemed necessary  

Physical Demands

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

• Vision: Moderate, Occasionally 0-30% of time

• Kneeling/Stooping/Bending: Occasionally 0-30%

• Standing/Walking: Occasionally 0-30%

• Pushing/Pulling: Occasionally 0-30%

• Intensity of Work: Occasionally 0-30%

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. 

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.