Population Health Specialist

Job description

Description
Position Summary:
The Population Health Specialist supports the organization's population health initiatives by coordinating patient outreach, identifying gaps in care, and assisting with preventive health screenings, Annual Wellness Visits (AWVs), and chronic disease management programs. This position works closely with clinical teams and the Population Health Manager to improve patient engagement, support quality performance measures, and promote positive health outcomes across the patient population.
Job Responsibilities:
• Identify and engage patients who are overdue for preventive screenings, Annual Wellness Visits (AWVs), chronic disease follow-ups, and other recommended healthcare services to improve patient outcomes and close gaps in care.
• Conduct and document daily patient outreach through phone calls, patient portal messages, and other approved communication methods, meeting established productivity goals for outreach attempts, successful patient contacts, appointment scheduling, and completed follow-ups.
• Collect, review, and maintain accurate patient information, health assessments, and required documentation while monitoring UDS, and other applicable quality measures. Maintain outreach tracking reports and provide regular updates on patient engagement, appointment conversion rates, and quality improvement outcomes.

Requirements
Required Knowledge, Skills & Abilities
• Strong organizational skills with attention to detail and accuracy.
• Excellent verbal and written communication skills.
• Ability to engage patients professionally and compassionately.
• Ability to manage multiple priorities and meet established deadlines.
• Basic understanding of preventive healthcare, chronic disease management, and population health initiatives.
• Ability to interpret patient information, identify gaps in care, and maintain accurate documentation.
• Ability to work independently and collaboratively within a multidisciplinary healthcare team.
• Commitment to patient confidentiality, healthcare quality, and improving community health outcomes.

Education/Experience:
Education & Experience Requirements
• Associate degree in Public Health, Health Sciences, Healthcare Administration, or a related field preferred; equivalent healthcare experience may be considered.
• Minimum of 1–2 years of experience in healthcare, patient outreach, care coordination, medical administration, or population health preferred.
• Familiarity with Electronic Health Records (EHR), preventive care screenings, and healthcare quality measures preferred.
• Experience with patient data collection, reporting, and Microsoft Office applications preferred.