Population Health Specialist II

The Population Health Specialist II processes Network Health authorization requests in accordance with established guidelines and triages authorization workflow. This role assists with Case Management assignment of candidates and operational support. This individual also assists with supporting and monitoring compliance with CMS/Federal regulatory and NCQA standards related to the authorization processes.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day.

Hours: 1.0 FTE, 40 hours per week, 7am - 5pm Monday through Friday

Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

• Enter authorization/pre-determination requests into information system according to Network Health policies, procedures and desk references
• 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

• High School Diploma required
• Two (2) years of health care experience in clinical or insurance setting required

Network Health is an Equal Opportunity Employer

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.