The Population Health team at LSCC manages organizational performance on clinical metrics, patient engagement, and cost containment for value-based contracts. Nurses on this team work in a central hub, remotely assisting clinic-based team members in managing panels of patients and closing any gaps in metric performance. As such, they are involved in report analysis, medical record review and abstraction, patient outreach and appointment scheduling. Indirect patient care is provided via telephonic and/or other electronic communications, and effectively engaging patients is an important part of this role.
Nurse Care Coordinators on the Population Health team are expected to work closely with the Chief Medical Information Officer and the Analytics team to develop reports that measure organizational performance against contracted metrics. Nurses must be able to skillfully dissect data reports to identify areas of concern and take ownership for the organizational improvement, maximizing the likelihood of the organization earning contracted incentives. When risks are identified, the nurses work as a team, collaborating with medical and executive staff, to develop a performance improvement plan. The Population Health team then continually measures results against that plan, communicating progress with the executive team, and correcting course when necessary.
Staff perform duties under the direction of the Chief Medical Information Officer, assisted by an RN Manager, to serve as patient advocates, providing remote-based care, system navigation, and education. This position provides direction to Licensed Vocational Nurses (LVNs) and Medical Assistants (MAs) as well as other non-licensed nursing personnel in the provision of patient care.
Daily Job Duties:
Utilize the Population Health team’s electronic ticketing system to track daily and weekly task assignments and mark completed tasks as done.
Participate and collaborate in team meetings.
All other duties as assigned
REQUIRED EXPERIENCE, EDUCATION, AND LICENSE:
PREFERRED EXPERIENCE, EDUCATION, AND LICENSE: