**Job Type:** Regular **Time Type:** Full time **Work Shift:** Day (United States of America) **FLSA Status:** Non-Exempt **When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.** Population Health Specialist - Job_Description_Under_Construction **Job Description:** Welcome to the Beth Israel Lahey Health Performance Network (BILHPN). BILHPN is a clinically integrated network of physicians, clinicians, and hospitals committed to providing high-quality, cost-effective care to the patients and communities they serve, while effectively managing medical expense. Leveraging best practices in population health management and data analytics, BILHPN improves care quality and patient health outcomes across Beth Israel Lahey Health through population health initiatives. BILHPN brings together the expertise of more than 4,500 providers across Eastern Massachusetts who share a common goal to achieve success in a value-based. Under the supervision of the Quality Manager, the Population Health Specialist (PHS) supports collaboration, communication and care coordination with all members of the health care team, including but not limited to POD leaders, practices, clinicians and hospital leadership. The Population Health Specialist is the primary point of contact with and an integral member of the health care team. They will work to ensure safety, best practice and high quality standards of care across the health care continuum to achieve the quality incentives as part of global payment and managed care contracts with the goal of optimizing our patients' health and well-being, ensuring that contractual metrics are met, and maximizing financial revenue in our quality risk arrangements. This role is responsible for the communication of targets for medical expense trend and quality outcomes and the facilitation of activities to meet identified targets through analysis of quality, cost and utilization reports. Assists the health care team in implementing and using systems and interventions to improve patient care and outcomes by identifying key drivers of performance and implementation of project plan(s) initiatives to impact those key drivers **Responsibilities are:** 1. Coordinates care for identified patients across the continuum in collaboration with physicians and all members of the health care team for populations identified by LCPN and supervised by the Director of Quality. 2. Serves as the liaison with patients, families to physicians, clinical staff, inclusive of Ambulatory Care Management, Inpatient Case Managers, and other departments within Lahey, 3rd party insurers involved with patient care, and community and post-acute care providers. 3. Advocates for patient and families, responds to and facilitates resolution of patient questions and concerns within scope of responsibilities. 4. Reviews, manages and enters registry health data for identified patient populations. 5. Extracts data from Optum and practice electronic medical record to support LCPN reporting and monitoring of quality performance. 6. Monitors compliance by the utilization of registries to proactively reach out to patients to assure they are making appointments, keeping scheduled appointments and complying with preventative care goals. 7. Reviews provider schedules and individual patient charts and assist the care team in coordinating care for visits and for future healthcare needs 8. Supports process improvement to enhance physician and staff workflow 9. Handles new patient outreach and non-compliant patient activation 10. Provides an effective communication link between patient and medical staff, including relaying messages from providers, gathering information from patients for providers etc. 11. Participates in team decisions regarding data requirements for pro-actively managing the team’s panel 12. Reviews registries with PCPs and/or key office staff to determine the next phase in patient care. Facilitates appointment scheduling, telephone outreach and directs patient to educational resources. 13. Coordinates with Director of Quality to track and share data with. **Education:** + Bachelors degree **Licensure, Certification & Registration:** + Medical Assistant Certification or 3-5 years related experience in a health care environment. **Experience:** 3-5 years related experience in a health care environment **Skills, Knowledge & Abilities:** + Strong knowledge of and experience with HEDIS ambulatory quality measures a must. + Ability to travel to offsite meetings at various provider practices and hospitals + Strong knowledge in Microsoft Office applications – Word, Excel, Access, PowerPoint and other web-based applications. May produce complex documents, perform analysis and maintain databasesKnowledge of process improvement initiatives such as LEAN or Six Sigma a plus + Knowledge of electronic medical records; eClinical Works, Athena, GE Centricity or Epic a plus **As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more (https://www.bilh.org/newsroom/bilh-to-require-covid-19-influenza-vaccines-for-all-clinicians-staff-by-oct-31) about this requirement.** **More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.** **Equal Opportunity** **Employer/Veterans/Disabled**