Population Health Coordinator - Medical Focus in New York at Jobgether

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Population Health Coordinator - Medical Focus based in the United States.

This role supports high-acuity and medically complex populations throughout critical stages of their care and recovery journey.
You will combine population health management, care coordination, data analysis, and direct member engagement to improve outcomes.
The position focuses on pregnant and postpartum members, recently hospitalized individuals, and members facing complex medical or substance-use-related needs.
Working within a Collaborative Care Model, you will partner closely with medical providers, counselors, specialists, and care teams across multiple regions.
You will help identify care gaps, monitor member progress, coordinate interventions, and contribute to quality improvement initiatives.
The role also provides opportunities to support innovative pilot programs and improve how care is delivered to vulnerable populations.
Success requires clinical expertise, adaptability, strong communication, and a genuine commitment to delivering compassionate, coordinated care.

• Maintain accurate member registries for specialized populations and care pathways, using data to track outcomes, assess progress, prioritize work, and support care-team decision-making.
• Facilitate regular registry reviews with counselors, medical providers, consulting specialists, and other interdisciplinary team members.
• Participate in caseload consultations and communicate treatment recommendations and care priorities to appropriate members of the care team.
• Analyze population-level data and care outcomes to identify opportunities for quality improvement and recommend initiatives that enhance care delivery.
• Perform and document internal and external care coordination activities for members with complex medical needs or challenging care scenarios.
• Support local care teams in applying the Collaborative Care Model and assist with training on registry reviews, asynchronous consultations, concise clinical presentations, and related workflows.
• Manage an assigned member caseload through telephone, SMS, and individual telemedicine interactions, providing screenings, structured assessments, brief interventions, and care coordination.
• Educate members about common physical health, mental health, and substance-use conditions, available treatment options, and strategies for navigating their care.
• Provide transitional care support to high-acuity members entering or progressing through recovery, including interdisciplinary meetings, orientation groups, care coordination, and individual support.
• Facilitate and document treatment-plan updates in collaboration with medical and clinical providers.
• Identify and escalate urgent or crisis situations to appropriate clinical or medical leadership and support follow-up and safety-planning activities.
• Support pilot projects by providing administrative, technical, analytical, and leadership assistance as delegated by medical, clinical, and operational leaders.
• For the Medical Focus, support medication management activities by monitoring adherence, side effects, and treatment effectiveness in accordance with provider direction.
• Help develop and deliver accessible, low-barrier, culturally appropriate educational materials covering addiction medicine, primary care, and other relevant medical topics.
• Review medical information and prepare documentation that enables medical colleagues to practice efficiently at the appropriate level of clinical expertise.
• Support medical-related care coordination and contribute across other population focus areas when needed to ensure comprehensive member support.

• Current Registered Nurse (RN) license, or, in Maine only, Licensed Practical Nurse (LPN) who completes the required SAMHSA training for an X-DEA license.
• Bachelor's degree in Nursing is preferred.
• At least 5 years of direct patient-care experience in addiction medicine, behavioral health, or a related clinical setting within a high-quality healthcare organization.
• Strong understanding of care coordination, case management, population health, and interdisciplinary care delivery.
• Knowledge of healthcare regulations, HIPAA requirements, and professional standards of conduct.
• Strong ability to communicate clearly and effectively with dispersed internal teams, external providers, and diverse member populations.
• Comfortable facilitating communication across telehealth, virtual platforms, telephone, and in-person care settings.
• Strong data-analysis skills, including the ability to interpret registries, outcomes, and other population health information to support care decisions.
• Excellent organizational and documentation skills, with the ability to manage multiple priorities accurately and efficiently.
• Proficiency with multiple electronic medical records, Microsoft Office or Google Workspace, spreadsheets, and other digital documentation tools.
• Strong problem-solving and decision-making capabilities, particularly when navigating complex or evolving care situations.
• Ability to build trust and rapport with diverse patient populations while maintaining appropriate professional boundaries.
• Demonstrated discretion, independence, adaptability, and the ability to work effectively under general supervision.
• Willingness to obtain additional training and adjust working hours within the normal work week when needed to accommodate member care.
• For remote work, reliable internet and telephone service are required, with recommended minimum speeds of 50 Mbps download and 10 Mbps upload and a strong Wi-Fi signal.
• Ability to meet and maintain applicable background-screening, credentialing, licensing, health-screening, CPR/Basic First Aid, and other state- or role-specific requirements.

• Competitive annual salary of $75,000–$90,000.
• Monday–Friday schedule, generally 8:00 AM–5:00 PM EST.
• Opportunity to contribute to innovative population health and Collaborative Care Model initiatives.
• Meaningful direct impact on high-acuity and medically complex member populations.
• Collaborative environment working alongside medical providers, counselors, specialists, peer support, and care-navigation professionals.
• Opportunities to contribute to pilot programs and continuous improvement initiatives.
• Professional development and additional training opportunities.
• Opportunity to work across interdisciplinary care settings and specialized population health programs.