Anthem In. Case Management Jobs

Job Information

Anthem, Inc. Outreach Specialist, Sr. in Pembroke Pines, Florida

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Simply Healthcare, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. We are a Florida licensed health maintenance organization that serves individuals enrolled in Medicaid and/or Medicare programs, Join us and together we will drive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.

Job Summary and Description:

  • Locate and engage members in the community (i.e. Hospitals, Assisted Living Facilities (ALF’s), Crisis stabilization Units (CSU), Substance Abuse Treatment programs, etc.) in efforts to engage them in care.

  • Gathers clinical information regarding case.

  • Researches and resolves complex customer and business issues.

  • Responds to telephone, written, and in-person inquiries and initiates steps to assist regarding issues relating to content or interpretation of benefits, policies, and procedures.

  • Supports Health Management Programs.

  • Performs new member orientations.

  • Assesses member compliance with medical and behavioral treatment through appointment completion rates.

  • Determines appropriate areas for referrals, and reaching systems such as Claims/Pharmacy, Florida resident database, and the justice systems to locate members and conduct Health Risk Assessments in the field.

  • Coordinates identification of and referral to local, state or federally funded programs

  • Provides education to members regarding all services available through the plan.

  • Supports member access to care through home visits, processing of reports, and distribution of collateral materials.

  • Decreases ER/Hospital Admissions through engagement.

  • Coordinates with CM and participates in Interdisciplinary Care Team (ICT) Meetings.

  • Provides timely and accurate resolution of inquiries and issues regarding benefits, services, and policies.

  • Supports and promotes State Sponsored Programs through participation in community events. Represents State Sponsored Programs in community collaborations.

  • Establishes and maintains relationships with Hospitals, Assisted Living Facilities (ALF'S), and Crisis stabilization Units (CSU).

  • Provides superior quality outcomes by taking ownership of issues to ensure timely resolution or follow-up.

  • Participates in promotional activities.

  • Provides superior, professional, and courteous service to customers.

  • Organizes daily work without significant guidance.

  • Maintains and updates tracking databases; prepares reports and documents all actions; responds to requests, calls or correspondence within scope.

  • Collaborates with team members to provide superior customer services.

  • Conducts research to assist customers with inquiries or issues.

  • Collaborates with external community-based organizations to facilitate and coordinate care (i.e. Ryan White, housing programs, legal aid, and/or other community based organizations that provide services to our members).

  • Actively identifies and pursues opportunities for team involvement.

  • Trains CRC associates. Provides leadership in the development and implementation of the Outreach Program and work plans.

  • Represents department with key internal and external stake holders and targeted community partners. Mentors and coaches Outreach staff.

  • Generates management reports.

Qualifications

The health and safety of our associates, members and communities is a top priority for Anthem. This priority has become increasingly important as we continue to face the challenges of the COVID-19 pandemic. Anthem believes vaccination is the best way to reduce the spread of COVID-19 and protect our members, our communities, our families and ourselves. To minimize the risk of transmission of the COVID-19 virus and maintain a safe and healthy workplace, vaccination is required for this role. (At Anthem, fully vaccinated means it has been at least two weeks since you have received the second dose of a two-dose vaccine such as Moderna or Pfizer, or the single dose of a single dose vaccine, such as Johnson & Johnson).

If you do not meet the requirements for this position, we encourage you to review other positions that currently allow virtual work. If you have a medical or sincerely held religious reason for not being vaccinated, consistent with applicable law, Anthem will consider requests for reasonable accommodation on this basis. Should you have any questions regarding the requirement after applying, email TalentAcquisition_VaccinationSupport@anthem.com.

Required Qualifications:

  • Requires a HS Diploma / GED Equivalency, a minimum of 4 years of customer service experience, understanding of the basic principles of managed care and the concepts of publicly financed health insurance such as Medicaid and SCHIP programs; or any combination of education and experience which would provide an equivalent background.

    Preferred Qualifications:

  • Case Management and/or Managed Care experience, strongly preferred.

  • Experience with one or more of the following populations a plus: HIV/AIDS, Behavioral Health, Substance Use Disorders, strongly preferred.

  • 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.

  • Bilingual

    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. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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.

    REQNUMBER: PS59873-Pembroke%20Pines-Pembroke%20Pines

DirectEmployers