Boston Health Care for the Homeless Program Hiring for Population Health Coordinator at Boston, MA Full Time

Since 1985, BHCHP’s mission has been to ensure unconditionally equitable and dignified access to the highest quality health care for all individuals and families experiencing homelessness in greater Boston. Over 10,000 homeless individuals are cared for by Boston Health Care for the Homeless Program each year. We are committed to ensuring that every one of these individuals has access to comprehensive health care, from preventative dental care to cancer treatment. Our clinicians, case managers, and behavioral health professionals work in more than 30 locations to serve some of our community’s most vulnerable—and most resilient—citizens.

From our earliest days as a program, we have always sought to do work that is transformational: recognizing our shared humanity; centering dignity, compassion, mutual respect and supporting the right of every individual to access the highest levels of health care and every staff member to reach their fullest potential. We continue to be committed to building bridges and breaking down barriers, including systemic racism which harms us all. We provide community-based health care services that are compassionate, dignified, and culturally appropriate, incorporating social determinants of health, with the goal of breaking down the physical and systemic barriers that our patients face.

Bilingual, Bicultural, LGBTQIA identifying, Black, Indigenous, and People of Color are encouraged to apply.

To learn more about working at BHCHP, watch our video

Job Summary:

Hours: Monday – Friday; 8:30am-5:00pm, hybrid schedule

Our dedicated clinical and non-clinical staff work hard to bring BHCHP’s mission alive. Beyond their immediate medical needs, patients often require assistance negotiating a confusing intersection of education, transportation, appointments, interpretation of results and follow up.

We are seeking a Population Health Coordinator to proactively manage health center populations with chronic conditions and those in need of preventative services to ensure the delivery of evidence-based care through a team-based, patient centered medical home approach under the direction of the Director of population Health. In this role, you will address gaps in care through outreach to patients in need of routine screening and/or chronic disease management. You will also schedule appointments and/or enter outside data to close care gaps to improve patient care and achieve quality performance goals.

Responsibilities:

Patient outreach and engagement

• Manages remote blood pressure monitoring program including, but not limited to, assisting patients in obtaining blood pressure cuffs, communicating with patients to obtain blood pressure readings, coordinating with medical providers and nurses regarding patients’ blood pressure readings, identifying barriers to blood pressure management.
• Utilizes the EHR and other web-based registry s to identify patients overdue for routine screening and chronic disease management; organizes and analyzes patient lists to prioritize outreach and data entry.
• Performs chart review in the EHR prior to outreach to verify if a patient is due for screening.
• Works collaboratively with health center providers and staff to address patient care needs.
• Utilizes population health registries and the EHR to generate and deliver population health reminders (i.e., letters, telephone, patient portal messages, or text messages); makes calls to patients and schedules appointments for patients who need routine care, routine screening, or chronic disease management.
• Verifies and updates demographic data in the Electronic Health Record (EHR).
• Provides data entry support to the primary care teams; assists with patient care services such as education, referral coordination, and transportation.
• Enrolls patients in the patient portal; communicates effectively, efficiently, and professionally over the phone with patients.
• Facilitates case conferences with care teams related to chronic diseases and assists with follow-up outreach; participates in and supports Chronic Disease Management Team.

Performance Improvement

• Reconciles patient charts to s to verify data accuracy; recognizes and s data inconsistencies to the Director of Quality in a timely manner.
• Improves patient care and data quality by entering external results in structured data fields in the EHR to record clinically relevant patient care performed outside of the health center; actively works to identify opportunities for improvement in workflows to improve population health and provides constructive ideas, suggestions, and feedback in a positive manner.
• Coordinates with Director of Quality and Director of Population Health to promote quality throughout the health center and troubleshoots areas of concern; participates in program-wide Quality and Efficiency Committee.
• Works with Director of Quality to create periodic performance data scorecard, dashboard, and gap lists on various program-wide quality indicators to share with various sites and care teams.

Qualifications:

• Bachelor’s Degree preferred, may be substituted for years of relevant experience.
• Experience working in healthcare setting with patient-focused experience preferred.
• Experience working with populations experiencing homelessness preferred.
• Bilingual in Spanish, Haitian Creole, Portuguese preferred.
• Highly motivated and mission-driven; highly organized and self-motivated individual with the ability to work autonomously.
• Ability to work independently as well as part of a team; collaborative working style with the ability to work with staff across different departments, teams, and roles.
• Ability to communicate effectively with diverse staff and patients with a warm and professional telephone manner.
• Skilled in use of Microsoft Office applications including Excel, Word, PowerPoint, and Outlook.
• Ability to balance multiple projects, prioritize effectively, and follow up to complete tasks; ability to learn HIPAA and adhere to data security best practices.
• Demonstrated interest in working with an undeserved population.

Compensation and Benefits:

• The compensation starts at $22.07 per hour and increases with years of experience.
• BHCHP full time employees are eligible for our competitive time off policy of 4 weeks’ vacation, health, dental and vision insurance, 403B retirement savings plan and employer retirement contribution, and pre-tax MBTA pass program with 40% discount. In addition, eligible employees will receive yearly increases, additional compensation of seven thousand five hundred added to your base hiring rate for demonstrated bilingual proficiency and the opportunity to work with local hospitals and community health centers.

Does this amazing opportunity interest you? Then we’d love to hear from you.

As an Equal Opportunity Employer, BHCHP pledges not to discriminate against and encourages those from underrepresented and underserved backgrounds to apply, particularly Black, Indigenous, and People of Color (BIPOC), LGBTQIA identifying, first generation college students and adults without a college degree, Bilingual and Bicultural persons; and individuals from low economic backgrounds.

Covid-19 Vaccination: Proof of Covid-19 vaccination(s) is optional for employment. Candidates who are offered employment will be given details about how to demonstrate receipt of vaccination if they choose to.

Please Note: Employment at Boston Health Care for the Homeless is at-will. Boston Health Care for the Homeless does not sponsor work authorization visas.

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