Outreach Care Specialist

Elevance Health • Nashville, TN

1d • Remote

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 clinical referrals and orders, coordinates follow-up care, and assesses member compliance with treatment plans by telephone or on-site visits. It identifies barriers to compliance and coordinates resolutions, supports medical record audits for HEDIS/Star program goals, and works with case management and providers on treatment plan modifications and additional services. The specialist also connects members with local, state, or federally funded programs, coaches them on reducing health risks, documents case and compliance updates, participates in cross-functional improvement activities, and maintains relationships with designated agencies.

This is a full-time virtual role for candidates within the CST and EST time zones, with required in-person training sessions. The stated schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. EST. Candidates must live within reasonable commuting distance of a posting location or an office, subject to the stated accommodation and alternate-location provisions.

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.
• Excellent verbal and written communication skills, including the ability to convey complex or detailed 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.
• Experience with clinical systems such as electronic medical records, care management, or population health management.

Responsibilities

• Initiate and manage clinical referrals and orders, including referrals to specialists, labs, and imaging centers.
• Coordinate follow-up care by scheduling appointments or enrolling members in programs.
• Assess member 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, projects, initiatives, and process-improvement activities.
• Establish and maintain relationships with agencies identified in the appropriate contract.

Benefits

• Merit increases
• Paid holidays
• Paid time off
• Incentive bonus programs, unless covered by a collective bargaining agreement
• Medical benefits
• Dental benefits
• Vision benefits
• Short- and long-term disability benefits
• 401(k) with matching
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED