[Hiring] Outreach Care Specialist @Elevance Health

Role Description

The Outreach Care Specialist is responsible for ensuring that appropriate member treatment plans are followed on less complex cases and for proactively identifying ways to improve the health of our members and meet quality goals.

• Initiates and manages clinical referrals and orders including but not limited to: Specialists, Labs and Imaging Centers.
• Coordinates follow-up care plan needs for members by scheduling appointments or enrolling members in programs.
• Assesses member compliance with medical treatment plans via telephone or through on-site visits.
• Identifies barriers to plan compliance and coordinates resolutions.
• Identifies opportunities that impact quality goals and recommends process improvements.
• Provides medical record audit support to support HEDIS/Star program goals.
• Recommends treatment plan modifications and determines need for additional services, in conjunction with case management and provider.
• Coordinates identification of and referral to local, state or federally funded programs.
• Coaches members on ways to reduce health risks.
• Prepares reports to document case and compliance updates.
• Participates in cross-functional teams on projects, initiatives, and process improvement activities.
• Establishes and maintains relationships with agencies identified in appropriate contract.

Qualifications

• Requires a H.S. diploma or equivalent and a minimum of 1 year related experience; or any combination of education and experience which would provide an equivalent background.
• BS/BA degree in a related field preferred.
• PTA/OTA with at least one year of experience preferred.
• Minimum 1 year of DME ordering experience preferred.
• Experience dealing with vendors and insurance companies preferred.
• Ability to manage multiple tasks at one time.
• Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook).
• Minimum 2 years’ experience with clinical systems (electronic medical record, care management, or population health management).
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or detailed information in a manner that others can understand.
• Bilingual candidates preferred.

Requirements

• Non-Management Non-Exempt job level.
• 1st Shift (United States of America) work shift.
• Job Family: MED > Care Coord & Care Mgmt (Non-Licensed).

Benefits

• Market-competitive total rewards including merit increases, paid holidays, and Paid Time Off.
• Incentive bonus programs (unless covered by a collective bargaining agreement).
• Medical, dental, and vision benefits.
• Short and long term disability benefits.
• 401(k) + match.
• Stock purchase plan.
• Life insurance.
• Wellness programs and financial education resources.