Population Health Specialist

Mosaic Community Health prides itself on being an innovative health system that pioneers unique and creative ways to provide and improve patient access to health care. Since our founding in 2002 we have proudly served insured and uninsured patients regardless of age, ethnicity, or income.
We focus on a holistic approach to patient care by incorporating behavioral health, pharmacy, and nutrition support to serve patients in the most meaningful way. At Mosaic Community Health, you will work with incredibly dedicated and mission-centered peers and be part of a dynamic team based environment.
Mosaic Community Health offers more than just a job, it is a lifestyle. A lifestyle of serving others. A lifestyle of being an integral part of your community. A lifestyle that offers work/life balance. A lifestyle of enjoying the outdoors! Central Oregon offers over 300 days of sunshine a year, so enjoy a PTO day on the mountain, biking/hiking trails, or the river! A lifestyle that improves lives, including yours. Of course, we also offer a great benefit package!
Opportunity

The Population Health Specialist (PHS) applies a broad range of professional quality improvement and population management skills to facilitate excellent quality, patient experience, and outcomes.  The PHS role is a significant contributor to Mosaic’s success in a value-based payment environment.  This role has three tiers that reflect varying levels of responsibility, project complexity, and expertise required. Please note that while this role is envisioned as a permanent position, it is contingent upon annual contract renewal, with the initial term set for one year.

Responsibilities

• Work with clinics to identify and test improvement ideas using “Plan-Do-Study-Act,” LEAN, and other standard improvement methods.
• Monitor clinic performance on key quality and patient health metrics and facilitate discussion at clinics about performance, goals, and improvement opportunities.
• Collaborate with clinical leaders to identify patient groups that require proactive outreach for preventive health maintenance and/or disease monitoring, including women’s health, diabetes, adolescent, flu shots, unestablished patients, etc.
• Work with clinics and other relevant departments to ensure Mosaic engages with patients on a regular basis using standard schedules and methods (phone calls, bulk mailings, My Chart, text messaging).
• Collaborate with appropriate clinic staff to work patient gap lists, which may include providing basic patient education and health coaching for non-complex needs (per script and care plan).
• Demonstrate knowledge of value-based contract requirements affecting Mosaic and collaborate with the Manager, Quality and Population Health to determine how the team can support contract requirements.

Skills & Knowledge

Basic personal computer skills and comfort with Microsoft Windows® operating system. EHR experience, EPIC experience a plus. Must possess the ability to work independently with strong organizational, communication and interpersonal skills to support the management of multiple priorities, at multiple locations, with significant attention to detail for completion of both verbal and written external communications.