Outreach Care Specialist I

Shift: Monday - Friday, 8:00am - 5:00pm EST

Location: Virtual, within CST and EST time zones

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered if candidates reside within a commuting distance from an office

Care Bridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. Care Bridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through homecare and community-based services.

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

How you will make an impact:

• 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 or enrolling members in programs.
• Assesses member 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
• Recommends treatment plan modifications and determines need for additional services, in conjunction with case management and provider.
• Coordinates identification of and referral to local, state or federally funded programs.
• Recommends treatment plan modifications and determines need for additional services, in conjunction with case management and provider.
• Coaches members on ways to reduce health risks.
• Prepares reports to document case and compliance updates.
• Participates in cross-functional teams on projects, initiatives, and process improvement activities.
• Establishes and maintains relationships with agencies identified in appropriate contract.

Minimum requirements:

• Requires a H.S. diploma or equivalent and a minimum of 1 year related experience; or any combination of education and experience which would provide an equivalent background.

Preferred skills, capabilities, and experiences:

• BS/BA degree in a related field preferred.
• PTA/OTA with at least one year of experience preferred.
• Minimum 1 year of DME ordering experience preferred
• Experience dealing with vendors and insurance companies preferred
• Ability to manage multiple tasks at one time
• Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook).
• Minimum 2 years' experience with clinical systems (electronic medical record, care management, or population health management).
• 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 the ability to understand and interpret complex clinical information from others.
• Bilingual candidates preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to…