Outreach Care Specialist (Remote)

Company :

Job Description : 

JOB SUMMARY

This job plays a critical role, within the clinical team, acting as the primary support for the clinical staff and as a liaison among all members of the care team, including the member themselves.  Works in tandem with the Clinical Care Coordinators to help facilitate execution of acute care and disease management, enabling the clinical team (Nurses and Social Workers) to optimize their workloads, helping to arrange required services for the member, and documenting appropriately. The incumbent requires working directly with members to appropriately identify those with acute care needs, gaps in care, and or immediate social needs and addressing those needs immediately to positively impact quality and care costs.  

ESSENTIAL RESPONSIBILITIES

• Assist members, at home or in the community, to assess and coordinate overall member care. Including obtaining medications or with medication prior authorization issues, and obtaining durable medical equipment/medical supplies.
• Conduct assessments, and screeners, to identify the health and wellness needs of members using a broad set of motivational interviewing skills with the goal of impacting members’ self-management skills and positive behavior changes which will ultimately positively impact member satisfaction and care costs.
• Address member identified needs for assistance and connect members with resources such as housing, finances, transportation, state waiver programs, and other services in the community.
• Provide appointment assistance and linkage to covered and non-covered services with the objective of facilitating member access to medically necessary services and identifying members who could benefit from wellness programs or services that address Health-Related Social Needs.
• Proactively incorporate lifestyle improvement opportunities and preventive care into member interactions.
• Educate members about plan benefits, and diagnoses, to support the provider’s plan of care and orders.
• Identify and address urgent discharge planning needs, and address member crises related to substance use, domestic violence, abuse/neglect, or related incidents.
• Collaborate, coordinate and communicate with the member’s treating provider(s) when clinical and psychosocial intervention is necessary.
• Ensure that all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards that support all lines of business.
• Other duties as assigned or requested.

EDUCATION

Required

• High School/GED

Substitutions

• None

Preferred

• Bachelor's degree

EXPERIENCE

Required

• 3 years in Clinical Care coordination of individuals with complex health conditions including: clinical care coordination of behavioral health conditions, or related experience.

Preferred

• 3 years in a medical related field such as Medical assistant

LICENSES or CERTIFICATIONS

Required

• None

SKILLS

• Ability to work in a virtual environment (e.g., provider offices, facilities and/or member’s homes); accomplishing and coordinating work remotely
• Basic knowledge of the health care delivery system including an understanding of health care costs drivers
• Ability to communicate, interact, and work effectively and cooperatively with all levels of staff and management teams
• Ability to handle many tasks simultaneously and respond to members and their issues promptly
• Ability to communicate well in person, via phone and via e-mail (verbally and written) 
• Proficient computer skills, including MS Office products
• Self-directed; self-starter; ability to work successfully with indirect supervision and moderate autonomy

Language (Other than English):

None

Travel Requirement:

50% - 75%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Rarely

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

No

Lifting: 10 to 25 pounds

No

Lifting: 25 to 50 pounds

No

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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