Outreach Care Specialist

This is a fully remote position, open to applicants in Kentucky, +3 more locations.

📋 Description

• Initiates and oversees clinical referrals and orders, which include specialists, laboratories, and imaging centers.

• Coordinates the necessary follow-up care plans by arranging appointments or enrolling members in relevant programs.

• Evaluates member adherence to medical treatment plans via telephone or through on-site assessments.

• Identifies obstacles to compliance with plans and facilitates solutions.

• Recognizes opportunities that affect quality objectives and suggests improvements in processes.

• Assists in medical record audits to support HEDIS/Star program objectives.

• Proposes modifications to treatment plans and assesses the necessity for additional services in collaboration with case management and providers.

• Facilitates the identification of and referral to local, state, or federally funded programs.

• Guides members on strategies to mitigate health risks.

• Compiles reports documenting case updates and compliance status.

• Engages in cross-functional teams for projects, initiatives, and process enhancement activities.

• Develops and sustains relationships with agencies specified in relevant contracts.

⛳️ Requirements

• High school diploma or equivalent, along with a minimum of 1 year of related experience; or any combination of education and experience that would provide an equivalent background.

• At least 1 year of experience in DME ordering is preferred.

• Background in dealing with vendors and insurance companies is preferred.

• Capability to manage multiple tasks simultaneously.

• Proficiency in Microsoft Office (Word, Excel, PowerPoint & Outlook).

• A minimum of 2 years’ experience with clinical systems (such as electronic medical records, care management, or population health management).

• Exceptional verbal and written communication skills.

• Ability to articulate clearly and concisely while conveying complex or detailed information understandably.

• Competence in understanding and interpreting intricate clinical information from others.

• Bilingual candidates are preferred.

• Must reside within a reasonable commuting distance from the posting location(s), unless accommodations are granted as required by law.

• PTA/OTA with at least one year of experience is preferred.

• A BS/BA degree in a related field is preferred.

🏝️ Benefits

• Merit increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• Short-term disability benefits.

• Long-term disability benefits.

• 401(k) with matching contributions.

• Stock purchase plan.

• Life insurance.

• Wellness programs.

• Financial education resources.

• Flexibility for virtual full-time work.

• Required in-person training sessions.

• Accommodation for the application process where applicable.