Anthem, Inc. Outreach Care Specialist in Metairie, Louisiana
SHIFT: Day Job
Responsible for serving as the initial and main point of Field contact between the Company and current members. 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: Coordinates follow-up care plan needs for members by scheduling appointments or enrolling members in programs. Responds to telephone, written, and in-person inquiries and initiates steps to assist regarding issues. Assesses member compliance with medical treatment plans via telephone or through on-site visits. Identifies barriers to plan compliance and coordinates resolutions. Identifies opportunities that impact quality goals and recommends process improvements. Recommends treatment plan modifications and determines need for additional services, in conjunction with case management and provider. Provides superior quality outcomes by taking ownership of issues to ensure timely resolution or follow-up. Coordinates identification of and referral to local, state or federally funded programs. Coaches members on ways to reduce health risks. Prepares reports to document case and compliance updates. Establishes and maintains relationships with agencies identified in appropriate contract. Comprehends the various cultural and linguistic needs of the Medicaid population, knowledge of the various health and social services available in the assigned region with a special emphasis on services offered by community based organizations, ability to work professionally with the company's associates, community-based organizations, providers and plan members.
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.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
Requires a high school diploma; 1 year of related experience; or any combination of education and experience, which would provide an equivalent background.
Must be live in or open to moving to Northern Louisiana without relocation assistance.
Certified nurse assistant or certified medical assistant and/or BS/BA degree in a related field preferred.
Bilingual candidates preferred.For URAC accredited areas the following applies:
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.