POPULATION HEALTH RESOURCE ASSOCIATE

Duke Connected Care, a community-based, physician-led network, includes a group of doctors, hospitals and other healthcare providers who work together to deliver high-quality care to Medicare Fee-for-Service patients in Durham and itssurrounding areas.

Occ Summary

The Population Health Resource Associate wi llimplement, plan andcoordinate comprehensive patient plans to ensure th atpatients receiveappropriate overall medical care, therapy and training services, in aneffort to enable their recovery or management of complex, chronic healthconditions. This work is done in conjunction with the Com plex Care Team(s).

Work Performed

Provide outreach an dcare management support to patients; educateclients of available commun ity resources. Assist clients withcoordination of care between healthcar eproviders and other complex careteam(s).Performs a range of non-clinica l care management functions (outreach,health education, informal counsel ing, social support, resourcelinkages, interpretation/ translation, tran sportation coordination, andadvocacy) for an active patient caseload tob uild individual andcommunity capacity by increasing health knowledge and self-sufficiencyand accurately documents activities with follow-up andp lans of action.Act as a client advocate and support the development ofpr oblem solvingskills; provide instructions in basic health care procedure s.Coordinate and/or participate in community health activities to includ epreparing patient education materials, brochures, bulletins, newsletter sand other promotional materials and/or publications. Attend off-site,o utreach education and recruitment sessions.Maintain liaison with otherpr ograms, offices and departments at Duke tocoordinate program businessand to accomplish program objectives.Interface with external organizations as appropriate to ensurecooperative efforts are enhanced and available r esources are utilized.Promote program on key coalitions and task forces to fostercollaboration, educate constituencies, leverage resources,and r educeduplication of services.Monitor and evaluate program effectiveness, investigate trends, andrecommend and implement modifications to improve program effectiveness.Prepare reports and conduct preliminary analyses setting forth progressand adverse trends.Perform other related dutiescui ty levelscan create a stressfulatmosphere.Additional responsibilitiesinc idental to the work described herein.The work activity and patient acoul d include:-- Make home visits and other contacts with clients,as necessa ry.Coordinates regular practice visits and attends provider meetings top romote coordination of patient care.-- Accompany clients to scheduled ap pointments and/or referral sites, asneeded.-- Serves as liaison tohealth /social services providers to build andmaintain effective relationships with physicians, site leadership,hospital staff and other community stak eholders to ensure timely andappropriate patient follow-up.Team Lead Res ponsibilities:-- Provides regular oversight (including accompaniment int o the field)of new hires and completes required performance adherence to programstandards and implements improvement and developmentplansas need ed.-- Utilize leadership principles to mobilize team to achieve positive outcomes.-- Conduct follow-up on outstanding matters to insure they ares uccessfully resolved.-- Represents program interests at internaland exte rnal meetings.-- Collect and analyze key statistics (disease registries, biometrics,care management productivity, etc.) to ensureadherence to es tablishedcare management protocols and benchmarks and investigates metho ds forimproving service delivery.-- Complete chart reviews and facilitat e peer review process amongassigned staff members.-- Utilizes data to im plement individual and program-level performanceimprovement activities ( standardization of care, establishment ofdisease and populationhealth me trics, consistency of reporting,information flow and management, job fun ctions).-- Assess training needs of new and existing staff, identifies a ndcoordinates continuing education, in-services and staff developmentopp ortunities to ensure that skill-sets adhere to established corecompetenc ies.

Knowledge, Skills and Abilities

The work activit yand patient acuity levels can create a stressfulatmosphere, therefore individuals successful in this job are:-- Organized andmotivated by a fa st-paced environment-- Able to manage multiple tasks/projects simultaneo usly-- Proficient in review and assessneeds quickly--Strong with the us e of computer software tools and data files-- Comfortable withcontinuous change and self-initiating-- Able to complete documentation in a quick and efficient manner (willbe in legal medical recordand othersoftware sy stems developed for caremanagement and population based program metrics)

Level Characteristics

Additional job expectations in clude the ability to:-- Maintain strict confidentiality-- Promote progra ms and services tocommunity-- Build effective andtrusting relationships with patient/peers-- Use motivational interviewing and active-listening skills whenassessing patient conditions, problemsand interests-- Use con flict-resolution skills when reaching consensusabout plans ofcare and tr eatment decisions-- Demonstrate confidence, compassion, political savvy, as well asattention to detail to apply these skills as decisions dictat e-- Use data to analyze trends and to verify data

Minimum Qualifications

Duke is an Equal Opportunity Employer committed to provi dingemployment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, geneticinformati on, national origin, race, religion, sex (including pregnancyand pregnan cy related conditions), sexual orientation or militarystatus.

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Duke aspires to create a community built on collaboration,inno vation, creativity, and belonging. Our collective success depends onthe robust exchange of ideas—an exchange that is best when the richdiversity of our perspectives, backgrounds, and experiences flourishes.To achieve this exchange, it is essential that all members of thecommunity feel se cure and welcome, that the contributions of allindividuals are respected , and that all voices are heard. All members ofour community have a resp onsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University andDuke University Healt h System may include essential job functions thatrequire specific physic al and/or mental abilities. Additionalinformation and provision for requ ests for reasonable accommodation willbe provided by each hiring departm ent.

Education

High school degree o r equivalent, as well as strong communications andorganizational skills.

Experience

Work generally requires customer service experience through patient orpublic contact.Two years of experience with customer interactions via phone andmarketing/communications preferred.A ctive user of electronic medical records software strongly preferred.An associate’s degree or higher may be substituted for experience.

D egrees, Licensures, Certifications

NA

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends onthe robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.