Medical Support Assistant - Population Health Support

Penobscot Community Health Center

Hampden, ME, USA

Published: 6/14/2022

Healthcare

Full Time

Job Description

Are you a pro at juggling schedules and keeping things running smoothly? Do you thrive on bringing order to the chaos—and making a real impact along the way? PCHC’s Care Management team is looking for a Medical Support Assistant – Population Health Support who’s passionate about health equity, proactive outreach, and improving outcomes for patients who need it most. In this key role, you’ll support our value-based care and population health efforts by coordinating schedules, supporting care teams, tracking key data, and helping close care gaps. If you’re detail-oriented, collaborative, and have at least one year of experience in a medical office setting, we’d love to meet you.

What’s it like to work at PCHC? Find out: https://www.youtube.com/watch?v=GyC3DFYq0zg

Schedule: Full-Time, Monday - Friday, Schedule TBD

Highlights of the Position:

Proactively Manage Scheduling for care management and population health services including: Annual Wellness Visits, Chronic Care Management, Transitional Care Management, and High-Risk Care Team Follow-Ups.
Identify & Engage High-Risk Patients: Use data tools like HealthInfoNet, the EMR, and population health dashboards to identify patients with complex needs or care gaps—and help connect them to timely, appropriate care.
Lead Proactive Patient Outreach: Conduct outreach to promote preventive care, encourage participation in care management programs, and ensure patients understand how to access the support they need—especially those facing barriers like transportation or scheduling.
Drive Care Gap Closure & Quality Initiatives: Collaborate across departments to support screening efforts, chronic condition follow-up, and equity-focused outreach campaigns that make a real impact on patient health.
Coordinate Seamless Scheduling & Follow-Up: Work closely with clinical teams to ensure patients are scheduled for the right appointments at the right time—especially those needing follow-ups, annual wellness visits, or chronic care management check-ins.
Track, Document & Report Outreach Efforts: Keep detailed records of patient interactions in both the EMR and population health dashboards to support quality reporting and ensure continuity of care.
Collaborate for Health Equity: Act as a connector between patients and internal teams—bringing cultural humility and a solutions-oriented mindset to every interaction.

Join PCHC's nationally recognized non-profit organization:

Federally Qualified Health Center offering integrated Medical Home Model
Collegial professional atmosphere with informed leadership
Flexible schedules supportive of work/life balance
Competitive compensation and generous benefits
PCHC provides comprehensive, patient-centered care with integrated services, including Psychiatry & Mental Health, Dental, Family Medicine, Pediatrics, Pharmacy, Geriatrics, Laboratory Services, Physical Therapy, and more!

Requirements:

High school diploma or equivalent required.
At least one year of healthcare experience, preferably in scheduling, outreach, or care coordination.
Proficiency in EMR systems, Microsoft Office, and data tracking/reporting tools.
Familiarity with ACO, value-based care, or population health concepts preferred.

Curious, or interested to learn more? Apply today! You can request a full copy of the detailed job description by emailing recruitment@pchc.com.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or any other characteristic protected by law.