Outreach Care Specialist I (HEDIS)

About the role

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 advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your

Requirements

• Certified nurse assistant or certified medical assistant and/or BS/BA degree in a related field preferred.
• Minimum 1-year of referral management and/or care coordination is preferred.
• Prior experience with clinical systems (EMR, care management or population health management) is strongly preferred.
• You should be very comfortable using Microsoft Word, Excel, Outlook and Teams.
• Bilingual candidates preferred.
• You must have excellent verbal and written communication skills; along with the ability to speak clearly and concisely. You will be conveying complex or detailed information in a manner that others can understand.
• Job Level:
• Non-Management Non-Exempt
• Workshift:
• 1st Shift (United States of America)
• Job Family:
• MED > Care Coord & Care Mgmt (Non-Licensed)
• 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.

Benefits

Additional Information

Anticipated End Date: 2026-06-29 Position Title: Outreach Care Specialist I (HEDIS) Job Description: Outreach Care Specialist I LOCATION : This is a virtual eligible role. You should be within a reasonable distance from one of our offices. HOURS : 7:00a -4:00p CT (8:00a - 5:00p ET), Monday through Friday Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), 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 accommodation is granted as required by law. The Outreach Care Specialist I 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. Primary duties may include, but are not limited to : 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 May coordinate follow-up care plan needs for members by scheduling appointments or enrolling members in programs. May assesses compliance with medical treatment plans via telephone visits. May recommend 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 vendors and/or agencies identified in appropriate contract. Required Qualifications 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.

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