Outreach Care Specialist Lead - Carelon
About The Position
The Outreach Care Specialist Lead- Carelon is responsible for ensuring that appropriate member treatment plans are followed on the most complex cases and for proactively identifying ways to improve the health of our members and meet quality goals. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from the posting location. 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.
Requirements
- Requires a H.S. diploma or equivalent and 5 years of related experience; or any combination of education and experience which would provide an equivalent background.
- Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Nice To Haves
- BH or MH experience.
- Certified nurse assistant or certified medical assistant.
- BS/BA degree in a related field.
- Bilingual candidates.
Responsibilities
- 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.
- 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.
- Establishes and maintains relationships with agencies identified in appropriate contract.
- Serves as a team lead.
- Participates in cross-functional teams on projects, initiatives, and process improvement activities.
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical, dental, vision
- Short and long term disability benefits
- 401(k) +match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
