Population Health Programs Consultant - VBC

Overview

Position Summary

Directly support the Orlando Health Network’s population health activities in various value-based care programs by coordinating clinical care delivery and supporting administrative services rendered to aligned patients. Serves to ensure high quality, efficient care is provided to such patients in all care settings, including pre-clinical/physician clinics, acute care hospitals, and post-acute facilities. Works with multi-disciplinary teams to support patients in the assessment of individual risk factors, development of comprehensive care pathways, clerical/administrative functions, and the advocacy for the patient to receive the best care possible.

About Orlando Health

Orlando Health is a trusted healthcare organization delivering professional and compassionate care to patients, families and communities across Florida. We offer benefits and career-growing programs to support you from day one.

• Coordinates with partner organizations and services to mitigate barriers to care, such as prescription drug programs, health and wellness programs, housing support services, durable medical equipment vendors, and public and private agencies, among others.
• Advocates for patients to optimize their health and wellbeing using evidence-based standards of care, encouraging effective self-management strategies, and via referrals to in-person and virtual resources.
• Completes chart reviews to assess unique patient needs to assist with designing broad and individualized care plan strategies, targeted health literacy and education materials, social determinants of health resources, and caregiver support plans.
• Contributes to problem solving through communication, collaboration, data collection, critical thinking, evaluation of options and potential solutions to further patient progress towards care plan goals.
• Maintains effective and efficient communication to guide the patient through their care journey using clinical pathways, by providing outreach services and advocating for the patient, as appropriate.
• Provides administrative support to assist with patient tracking, reporting, and stratification.
• Helps support system objectives and strategic imperatives by implementing plan level or program level strategies.
• Takes initiative to develop knowledge, skills, and abilities to perform at a high level, including staying abreast of Centers for Medicare & Medicaid Services (CMS) programs and guidelines.
• Communicates effectively with multidisciplinary teams across Orlando Health as appropriate and necessary, to ensure patients receive the most coordinated care possible in collaboration with all external stakeholders.
• Collaborates with various healthcare entities and physician practices to foster integrated relationships with patients, families, and caregivers, and to facilitate a streamlined patient experience across the continuum of care.
• Maintains a high level of proficiency with organizational information systems, including ELLiE and the associated Healthy Planet modules, to ensure collaborative support for the covered populations is efficient, timely, and effective.
• Attend team meetings regularly with active engagement and collaboration.
• Supports the OHN Medical Directors and network leadership regarding clinical transformation efforts to support the Quadruple Aim within the clinically integrated network.
• Participates in multidisciplinary teams to review standards and suggest care pathway improvements for use in applicable clinically integrated network business and clinical engagements.
• Actively supports ELLiE deployments, product development, and system maintenance post-implementation, specifically, as it pertains to the Epic Healthy Planet module.
• Leads and organizes multi-party collaborative project meetings, including preparation of agendas, plans, and recommendations related to program performance, opportunity assessment, and care strategies.
• Acts as a brand ambassador to create awareness and promote the department by serving as a spokesperson to encourage collaboration across the system and achieve strategic imperatives.
• Understands broad principles related to care management, healthcare operations, value-based care, insurance and payor relationships, organizational and departmental strategies, patient engagement, physician relations, and all other relevant clinical care delivery requirements.
• Performs other duties as assigned to support the health system’s overall population health and value-based care team objectives.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

• Works comfortably in teams as a participant, including temporary teams for project-based initiatives.
• Possesses the ability to prioritize and work independently in addition to being an integral part of the care team.
• Communicates…