Outreach Care Specialist

Elevance Health • Nashville, TN

6d • Remote

About The Position

The Outreach Care Specialist 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, assesses member compliance, identifies barriers, and works with case management and providers on treatment plan modifications and additional services. The position also supports medical record audits for HEDIS/Star goals, coaches members on reducing health risks, documents case and compliance updates, participates in cross-functional improvement work, and maintains relationships with relevant agencies.

This is a virtual full-time role for associates in 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 be within reasonable commuting distance of the posting location(s), subject to the stated accommodation policy.

Requirements

• High school diploma or equivalent and at least 1 year of related experience, or an equivalent combination of education and experience.
• Ability to manage multiple tasks at one time.
• Proficiency with Microsoft Office, including Word, Excel, PowerPoint, and Outlook.
• Excellent verbal and written communication skills, including the ability to communicate complex information clearly and understand and interpret complex clinical information.

Nice To Haves

• Bachelor of Science or Bachelor of Arts degree in a related field.
• PTA/OTA credential with at least 1 year of experience.
• At least 1 year of DME ordering experience.
• Experience dealing with vendors and insurance companies.
• At least 2 years of experience with clinical systems, such as electronic medical record, care management, or population health management systems.
• Bilingual ability.

Responsibilities

• Initiates and manages clinical referrals and orders, including referrals to specialists, labs, and imaging centers.
• Coordinates follow-up care plan needs by scheduling appointments or enrolling members in programs.
• Assesses member compliance with medical treatment plans by telephone or through on-site visits.
• Identifies barriers to treatment plan compliance and coordinates resolutions.
• Identifies opportunities that affect quality goals and recommends process improvements.
• Provides medical record audit support for HEDIS/Star program goals.
• Recommends treatment plan modifications and determines the need for additional services in conjunction with case management and providers.
• Coordinates identification of and referrals to local, state, or federally funded programs.
• Coaches members on ways to reduce health risks.
• Prepares reports documenting case and compliance updates.
• Participates in cross-functional teams, projects, initiatives, and process improvement activities.
• Establishes and maintains relationships with agencies identified in appropriate 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

What This Job Offers

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