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Population Health Management Specialist - Call Center


- Contract  
Job Description

Working Title: Population Health Management Specialist - Call Center                                                                  


3-6 month contract - Pay up to $24/hr - Potential for conversion to permanent employment

Primary Purpose of Position:

The Population Health Management Specialist is an integral part of an innovative team of care coordinators including clinicians, RNs and Qualified Professionals delivering comprehensive clinical and integrated healthcare across a variety of delivery systems. This position will be responsible for monitoring the continuum of care activities to improve population health outcomes and quality of care.  This position will provide telephonic member support, monitor compliance and adherence to treatment and identify potential risk factors that determine additional referrals.  The goal of this position is to provide a variety of support functions to contribute to the overall improvement of healthcare quality of life, as well as efficient use of resources.  This position monitors members to ensure that they are linked and engaged to the appropriate service and are offered additional services as needed if any changes transpire with the member.

Essential Functions:
The Population Health Management Specialist is responsible for (though not limited to):
  • Completes Transition to Community Living quality of living survey with compliance to state and Cardinal Innovations requirements
  • Provides telephonic member support for individuals that meet criteria for additional monitoring to ensure engagement, compliances, and adherence to identified treatment goals
  • Uses a script to determine potential risk factors and/or barriers to care that contribute to negative treatment outcomes and makes referrals as needed to ensure member success
  • Coordinates and facilitates referrals identified to appropriate department
  • Remains knowledgeable on Cardinal Innovations array of support, trainings, and offerings and provides information as needed
  • Remains knowledgeable on disease processes and provides preliminary member education as needed
  • Provides outbound calls to members enrolled in Population Health Management Care and documents all member activities accurately in clinical database
  • Actively coordinates referrals with Access, Community Offices, and Care Coordination to facilitate quality improvement and positive outcomes of members
  • Utilizes predetermined criteria to identify and plan strategies for engaging members in continuum of care
  • Analyzes data to identify at-risk members who meet population health triggers. Maintains oversight of data regarding member through population health management discharge
  • Collaborates with departments such as Access, Community Offices, and Community Partners to determine member needs and the availability of services that can be communicated to the member, including Cardinal trainings and workshops
  • Reviews available information obtained by the Care Coordination system to consider physical, cultural, psychosocial, spiritual, and other needs of the member. Subsequently, performs follow-up calls to members regarding their experience and issue resolution as needed
  • Ensures that member has been connected with information and/or services in order to address continuity of care provided
  • Bridges any identified gaps between the member, Cardinal, provider, and other community stakeholders
  • Utilizes IT systems and analyzes reports to provide proper outreach to high-risk members potentially requiring preventive or chronic care
  • Works collaboratively and maintains active communication with all members or the multidisciplinary care team in an effective, timely manner through the continuum
This resource should be actively engaged in suggested and/or required trainings and education in an effort to continue the development and current knowledge necessary for the role. This role will maintain a working knowledge of the IT applications used for Care Coordination services. In addition, the resource will remain compliant with quality guidelines and expectations set by Cardinal.
Work is completed with a considerable degree of independence. Work will be reviewed by supervisor on a regular basis. Supervisor will be available for reviews, meetings and questions.
Knowledge, Skills and Abilities:  
  • Excellent and high-level analytical/problem solving skills and communication skills, both orally and written
  • Knowledge of and ability to effectively facilitate quality enhancement efforts, particularly as it relates to clinical outcomes
  • Ability to establish and maintain positive and effective working relationships with others both within the company and community
  • Ability to demonstrate initiative and effective problem-solving skills
  • Functional computer skills (Microsoft Office)
Required Education, Training and Experience: 
Bachelor’s degree in psychology, business, healthcare or related discipline is required. 2 years of experience in Mental Health, Substance Use Disorder, or related field. Call Center experience preferred.