Outreach Care Specialist
About The Position
The Outreach Care Specialist I ensures that appropriate member treatment plans are followed in less complex cases and proactively identifies ways to improve member health and meet quality goals. The role initiates and manages referrals, coordinates follow-up care, assesses treatment-plan compliance, identifies barriers, and connects members with additional services and community programs. The position also supports medical record audits and quality initiatives, coaches members on reducing health risks, documents case updates, and maintains relationships with contracted agencies. This is a full-time virtual role for candidates in the CST or EST time zones, with required in-person training sessions. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. EST. Candidates must live within a reasonable commuting distance of the posting location or an office, subject to the stated policy and applicable accommodations.
Requirements
- High school diploma or equivalent, and at least 1 year of related experience; or an equivalent combination of education and experience.
- Proficiency with Microsoft Office, including Word, Excel, PowerPoint, and Outlook.
- Experience with clinical systems such as electronic medical records, care management, or population health management.
- Excellent verbal and written communication skills, including the ability to convey complex information clearly and understand and interpret complex clinical information.
Nice To Haves
- Certified nurse assistant or certified medical assistant credential and/or a bachelor’s degree in a related field.
- At least 1 year of referral management and/or care coordination experience.
- Bilingual ability.
Responsibilities
- Initiate and manage clinical referrals and orders, including referrals to specialists, labs, and imaging centers.
- Coordinate members’ follow-up care needs by scheduling appointments or enrolling members in programs.
- Assess members’ compliance with medical treatment plans by telephone or through on-site visits.
- Identify barriers to treatment-plan compliance and coordinate resolutions.
- Identify opportunities to affect quality goals and recommend process improvements.
- Support medical record audits for HEDIS/Star program goals.
- Recommend treatment-plan modifications and determine the need for additional services in conjunction with case management and providers.
- Coordinate identification of and referrals to local, state, or federally funded programs.
- Coach members on ways to reduce health risks.
- Prepare reports documenting case and compliance updates.
- Participate in cross-functional teams working on projects, initiatives, and process improvements.
- Establish and maintain relationships with agencies identified in applicable contracts.
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs, unless covered by a collective bargaining agreement
- Medical benefits
- Dental insurance
- Vision insurance
- Short- and long-term disability benefits
- 401(k) with 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
Entry Level
Education Level
High school or GED
