Atrius Health, an innovative healthcare leader, delivers an effective system of connected care for more than 690,000 adult and pediatric patients at 30 medical practice locations in eastern Massachusetts. Atrius Health’s 645 physicians and primary care providers, along with 420 additional clinicians, work in close collaboration with hospital partners, community specialists and skilled nursing facilities. Our vision is to transform care to improve lives. Atrius Health provides high-quality, patient-centered, coordinated, cost effective care to every patient we serve. By establishing a solid foundation of shared decision making, understanding and trust with each of its patients, Atrius Health enhances their health and enriches their lives. Atrius Health is part of Optum, a health services company focused on building the leading value-based care system in the country.

As a member of the clinical care team, is responsible for supporting efforts to meet Atrius quality goals by facilitating both routine preventative care and ongoing chronic disease management for primary care patients. Works in a matrix function with overall direction from clinical and administrative leadership at the IM Service Line and the Performance Excellence department, and daily supervision from clinical and administrative leadership at the IM practice site. Identifies and articulates opportunities for work flow changes to improve quality of care related to the organizational strategic quality goals. Understands complex characteristics of the quality metrics and translates the metrics into actionable workflows for the clinical practice. Serves as the organizer and driver of population management outreach work at the site, and plays a key support role for onboarding patients to the practice. Navigates data for large populations of patients to identify recommended clinical care opportunities and subsequently organizes and prioritizes action items, including allocating tasks to the appropriate member of the care team and ensuring efforts are coordinated and avoid duplication.

Manages a high volume of patient outreach for patient populations with chronic illnesses (e.g., diabetes, hypertension and cardiovascular disease) as well as for primary care patients needing preventative screening tests within the broader patient population. Builds relationships with patient in order to assist the primary care team in developing an effective and accessible plan of care and ultimately tracks adherence to this plan of care.

Note: The role of Population Management Care Facilitator involves complex and detail-oriented responsibilities, the ability to understand and articulate clinical terms and processes and the ability to interact with patients and clinicians about preventative health and chronic disease management.

SUPERVISORY RESPONSIBILITIES

§ None

EDUCATION/LICENSES/CERTIFICATIONS

High School diploma or equivalency certificate (e.g. GED, HiSET, TASC Test) from an accredited institution or governmental unit required. Associates Degree or some college preferred.

EXPERIENCE

Skills and experience typically acquired through three years in a clinical business support, research, or ambulatory care setting. Previous training or experience work in population health management preferred. EMR experience and/or aptitude to master the EMR based on other technology experience required.

SKILLS

Proficiency in data management, including the ability to extract data and develop spreadsheets, required. Knowledge and understanding of medical terminology strongly preferred. Proficiency in Microsoft Office, especially Excel is required.

Strong interpersonal skills with the ability to build productive relationships with physicians, other professionals, internal staff and patients. Excellent time management and organizational skills required with the ability to manage multiple quality initiatives. Ability to work with a high degree of detail in a busy and demanding environment. Must possess effective communication skills both verbal and written, in the English language. Ability to work independently as well as within the network for the clinical department and the larger population management coordinator group. Excellent phone skills, strong customer service and ability to build relationships with patients by phone are required.

OTHER REQUIREMENTS

Able to use all electronic tools and applications relevant to the performance of the duties of the position, including but not limited to phone, keyboard, computer and computer applications.

Performs all job functions in compliance with applicable federal, state, local and company policies and procedures.

Accesses only the minimum necessary protected health information (PHI) for the performance of job duties. Actively protects the confidentiality and privacy of all protected health information they access in all its forms (written, verbal, and electronic, etc.) taking reasonable precautions to prohibit unauthorized access. Complies with all Atrius Health and departmental privacy policies, procedures and protocols. Follows HIPAA privacy guidelines without deviation when handling protected health information.

WORKING CONDITIONS / PHYSICAL DEMANDS

Busy medical/clinical office environment with frequent deadlines and interruptions.

Excellent benefits Includes

· Up to 8% company retirement contribution,

· Generous Paid Time Off

· 10 paid holidays,

· Paid professional development,

· Competitive health and welfare benefit package.

Atrius Health is an equal opportunity/affirmative action employer and does not discriminate in recruiting, hiring, training, promoting or any other employment practices on the basis of race, color, religion, sex, marital status, age, sexual orientation, gender identity, national origin, military service or application for military service, veteran or disability status.

Applicants have rights under Federal Employment Laws: Family and Medical Leave Act (FMLA);Equal Employment Opportunity (EEO); and Employee Polygraph Protection Act (EPPA).

VEVRAA Federal Contractor

Request Priority Protected Veteran & Disabled Referrals for all of our locations within the state