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Role Description

The Outreach Care Specialist II is responsible for ensuring that appropriate member treatment plans are followed on moderately complex cases and for proactively identifying ways to improve the health of our members and meet quality goals.

• Initiates and manages clinical referrals and orders including but not limited to: Specialists, Labs and Imaging Centers
• Coordinates follow-up care plan needs for members by scheduling appointments with specialists or enrolling members in programs.
• Assesses 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.
• Medical record audit support to support HEDIS/Star program goals
• 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.
• Participates in cross-functional teams on projects, initiatives, and process improvement activities.
• Establishes and maintains relationships with vendors identified in appropriate contract.

Qualifications

• Requires a H.S. diploma or equivalent and a minimum of 3 years of related experience; or any combination of education and experience which would provide an equivalent background.
• 2+ years of referral management and/or care coordination preferred.
• BS/BA degree in a related field preferred.
• Bilingual candidates preferred.
• 3+ years of experience in healthcare industry preferred.
• Certification/licensure in clinical or healthcare related field (i.e., Certified nurse assistant/medical assistant) with at least 2 years of patient-facing experience preferred.
• 3+ years of experience with EMR, medical records or patient-facing interaction in any healthcare environment preferred.
• 1+ years of clinical quality (HEDIS/Stars), and clinical data collection, abstraction or validation preferred.
• Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook) preferred.
• Experience with clinical systems (electronic medical record, care management or population health management) preferred.
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or detailed information in a manner that others can understand, as well as ability to understand and interpret complex clinical information from others preferred.

Requirements

• Job Level: Non-Management Non-Exempt
• Workshift: 1st Shift (United States of America)
• Job Family: MED > Care Coord & Care Mgmt (Non-Licensed)

Benefits

• Market-competitive total rewards including merit increases, paid holidays, Paid Time Off, and incentive bonus programs.
• Medical, dental, vision, short and long term disability benefits.
• 401(k) + match.
• Stock purchase plan.
• Life insurance.
• Wellness programs and financial education resources.