Outreach Care Specialist (Remote)

Company :

Highmark Inc.

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)<