Outreach Care Specialist I

Elevance Health•Atlanta, OH

1d•Remote

About The Position

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. 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.
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.

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
Bilingual candidates preferred.

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.
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 agencies identified in appropriate contract.