Population Health Specialist I

The Population Health Specialist I provides operational support for the Case, Condition Management, Quality, Wellness, Pharmacy, Government Relations, and Utilization Management Departments including requesting and extracting medical records and provider outreach for HEDIS, Health Risk Assessments, Primary Care Provider Attributions, and CIOX medical records, and incoming and outgoing postal mail (requires in-office attendance on a rotating basis). This role is also responsible for various outbound member calls, including but not limited to new welcome calls, service recovery opportunities, etc. This role assists with supporting and monitoring compliance with CMS federal regulatory and NCQA standards related to the authorization process.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day.

Hours: 1.0 FTE, 40 hours per week, 7:30am – 5pm Monday through Friday

Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

• Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies.
• Assign case and condition candidates received via referrals/triggers to appropriate Care or Condition Management Coordinator.
• Interact with member, practitioner/provider, or other entities via telephone calls, faxes, emails or letters related to authorizations, case management, claims and benefit inquiries
• Collect member or provider specific information telephonically or electronically as requested.
• Assist in mentoring of new employees as needed.
• May assist with other non-clinical projects and tasks when needed.
• Other duties as assigned

Job Requirements:

• High School Diploma required
• 1 year of health care experience in clinical or insurance setting preferred

Network Health is an Equal Opportunity Employer