Population Health Specialist I

Network Health WI•Menasha, WI

15h•Hybrid

About The Position

The Population Health Specialist I provides operational support for the Case, Condition Management, Quality, Wellness, Pharmacy, Government Relations, and Utilization Management Departments. This role involves requesting and extracting medical records and provider outreach for HEDIS, Health Risk Assessments, Primary Care Provider Attributions, and CIOX medical records, as well as managing incoming and outgoing postal mail (requiring in-office attendance on a rotating basis). The role is also responsible for various outbound member calls, including new welcome calls and service recovery opportunities. Additionally, this position assists with supporting and monitoring compliance with CMS federal regulatory and NCQA standards related to the authorization process. Candidates must reside in Wisconsin and will work from their home office with occasional travel to the corporate office in Menasha. The position is 1.0 FTE, 40 hours per week, with hours from 7:30 am to 5 pm, Monday through Friday. A start date between August and September 2026 is anticipated.

Requirements

High School Diploma required
1 year of health care experience in clinical or insurance setting preferred

Responsibilities

Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies.
Assign case and condition candidates received via referrals/triggers to appropriate Care or Condition Management Coordinator.
Interact with member, practitioner/provider, or other entities via telephone calls, faxes, emails or letters related to authorizations, case management, claims and benefit inquiries.
Collect member or provider specific information telephonically or electronically as requested.
Assist in mentoring of new employees as needed.
May assist with other non-clinical projects and tasks when needed.
Other duties as assigned