Outreach Care Specialist I

Elevance Health•Tampa, OH

1d•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 role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered if candidates reside within a commuting distance from an office.

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.

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.
Bilingual candidates preferred.
Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook).
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 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 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.
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.