Outreach Care Specialist I (HEDIS)

Elevance Health•Nashville, TN

2d•Remote

About The Position

The Outreach Care Specialist I 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. This is a virtual eligible role, meaning associates can work virtually full-time, with the exception of required in-person training sessions. Candidates must be within a reasonable commuting distance from one of our offices. The role operates Monday through Friday from 7:00a - 4:00p CT (8:00a - 5:00p ET).

Requirements

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.
Excellent verbal and written communication skills.
Ability to speak clearly and concisely.
Ability to convey complex or detailed information in a manner that others can understand.
Comfortable using Microsoft Word, Excel, Outlook and Teams.

Nice To Haves

Certified nurse assistant or certified medical assistant and/or BS/BA degree in a related field preferred.
Minimum 1-year of referral management and/or care coordination is preferred.
Prior experience with clinical systems (EMR, care management or population health management) is strongly preferred.
Bilingual candidates preferred.

Responsibilities

Identifies barriers to plan compliance and coordinates resolutions.
Identifies opportunities that impact quality goals and recommends process improvements.
Medical record audit support to support HEDIS/Star program goals.
May coordinate follow-up care plan needs for members by scheduling appointments or enrolling members in programs.
May assess compliance with medical treatment plans via telephone visits.
May recommend treatment plan modifications and determines need for additional services, in conjunction with case management and provider.
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/or agencies identified in appropriate contract.