Job Description

Working/Functional Title

Population Health Coordinator

Position Summary

The Population Health Coordinator supports MSU Health Care's quality, population health, and value-based care initiatives in partnership with the MOSAIC Clinically Integrated Network (CIN), Accountable Care Organization (ACO), and Henry Ford Health. This role works closely with providers, practice teams, and quality leadership to improve patient outcomes, close care gaps, enhance preventive care, and support organizational performance on quality measures and value-based contracts.

Using data-driven outreach and care coordination strategies, the Population Health Coordinator helps patients navigate the healthcare system, access necessary services, and achieve better health outcomes while advancing the goals of population health, health equity, and patient-centered care.

Key Responsibilities:

• Identify and address care gaps through patient outreach, chart review, and population health reporting tools.
• Support quality initiatives related to preventive screenings, chronic disease management, immunizations, and Annual Wellness Visits.
• Utilize Epic, registries, dashboards, and performance reports to prioritize outreach and intervention opportunities.
• Assist patients in navigating care across primary care, specialty care, hospital, and community settings.
• Support transitions of care following emergency department visits, hospitalizations, and post-acute care encounters.
• Collaborate with providers, practice staff, care managers, community health workers, and quality teams to improve outcomes and patient engagement.
• Conduct and support Social Determinants of Health (SDOH) screening and connect patients with community resources.
• Educate patients on preventive care, chronic disease management, MyChart utilization, and available support services.
• Support CIN, ACO, PCMH, and value-based care initiatives through data collection, reporting, workflow implementation, and performance improvement activities.
• Provide education and support to clinic teams regarding quality measures, care gap workflows, and population health best practices.

Minimum Requirements

Knowledge normally acquired from specialized training such as that acquired in two to three years of college in healthcare, science, or business school with coursework in a field related to the medical or ambulatory clinical experience; one to three years of related and progressively more responsible or expansive work experience in performing tasks related to the area of employment; experience with electronic medical records and electronic scheduling systems; experience in data analysis and reporting; experience in healthcare quality programs; experience in the use of spreadsheet, word processing, and database software; or an equivalent combination of education and experience.

Equal Employment Opportunity Statement

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, age, disability or protected veteran status.

Required Application Materials

Resume

Cover letter

Work Hours

STANDARD 8-5

Website

https://healthcare.msu.edu/

Summary of Health Risks

Exposure to human blood, serum, and other body fluids; and materials covered under Universal Precautions; TB risk or work within three (3) feet of patients in a health care setting; wear a respirator.

The Bidding Eligibility ends on 11/03/2026 at 11:55 PM