Outreach Care Specialist I

Elevance Health•Durham, NC

19h•Hybrid

About The Position

CareBridge Health, a proud member of the Elevance Health family of companies within the Carelon business, aims to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through homecare and community-based services. 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 members and meet quality goals. This is a virtual eligible role, with the exception of required in-person training sessions when indicated, providing maximum flexibility and autonomy. The role operates Monday through Friday, 7:00a - 4:00p CT (8:00a - 5:00p ET).

Requirements

H.S. diploma or equivalent
Minimum of 1 year related experience; or any combination of education and experience which would provide an equivalent background

Nice To Haves

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, as well as the ability to understand and interpret complex clinical information from others

Responsibilities

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 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.
Medical record audit support to support 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 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.