Outreach Care Specialist I
Elevance Health, Nashville, TN, United States
Outreach Care Specialist I
CareBridge Health is a proud member of the Elevance Health family of companies. The Outreach Care Specialist I ensures that appropriate member treatment plans are followed on less complex cases and proactively identifies ways to improve the health of our members and meet quality goals.
Location
This is a virtual eligible role. You should be within a reasonable distance from one of our offices.
Hours
7:00 a.m. - 4:00 p.m. CT (8:00 a.m. - 5:00 p.m. ET), Monday through Friday.
Responsibilities
Initiates and manages clinical referrals and orders including specialists, labs, and imaging centers.
Coordinates follow‑up care plan needs for members by scheduling appointments or enrolling members in programs.
Assesses compliance with medical treatment plans via telephone 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 meet HEDIS/Star program goals.
Coordinates identification of and referral to local, state, or federally funded programs.
Recommends treatment plan modifications and determines need for additional services in conjunction with case management and providers.
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 vendors and agencies as identified in appropriate contract.
Required Qualifications
Requires a high school diploma or equivalent and a minimum of one year related experience; or any combination of education and experience providing an equivalent background.
Preferred Qualifications
BS/BA degree in a related field preferred.
PTA/OTA with at least one year of experience preferred.
Minimum one year of DME ordering experience preferred.
Experience dealing with vendors and insurance companies preferred.
Ability to manage multiple tasks simultaneously.
Microsoft Office proficiency (Word, Excel, PowerPoint, Outlook).
Minimum two 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, convey complex or detailed information, and understand and interpret complex clinical information from others.
Equal Employment Opportunity
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, and local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/).
#J-18808-Ljbffr
CareBridge Health is a proud member of the Elevance Health family of companies. The Outreach Care Specialist I ensures that appropriate member treatment plans are followed on less complex cases and proactively identifies ways to improve the health of our members and meet quality goals.
Location
This is a virtual eligible role. You should be within a reasonable distance from one of our offices.
Hours
7:00 a.m. - 4:00 p.m. CT (8:00 a.m. - 5:00 p.m. ET), Monday through Friday.
Responsibilities
Initiates and manages clinical referrals and orders including specialists, labs, and imaging centers.
Coordinates follow‑up care plan needs for members by scheduling appointments or enrolling members in programs.
Assesses compliance with medical treatment plans via telephone 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 meet HEDIS/Star program goals.
Coordinates identification of and referral to local, state, or federally funded programs.
Recommends treatment plan modifications and determines need for additional services in conjunction with case management and providers.
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 vendors and agencies as identified in appropriate contract.
Required Qualifications
Requires a high school diploma or equivalent and a minimum of one year related experience; or any combination of education and experience providing an equivalent background.
Preferred Qualifications
BS/BA degree in a related field preferred.
PTA/OTA with at least one year of experience preferred.
Minimum one year of DME ordering experience preferred.
Experience dealing with vendors and insurance companies preferred.
Ability to manage multiple tasks simultaneously.
Microsoft Office proficiency (Word, Excel, PowerPoint, Outlook).
Minimum two 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, convey complex or detailed information, and understand and interpret complex clinical information from others.
Equal Employment Opportunity
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, and local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration (https://info.flclearinghouse.com/).
#J-18808-Ljbffr