What are the responsibilities and job description for the Population Health Specialist II position at Network Health?
The Population Health Specialist II 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. This role assists with supporting and monitoring compliance with CMS federal regulatory and NCQA standards related to the authorization process. The Population Health specialist II may also be responsible for various outbound member calls, including new welcome calls, service recovery opportunities, etc.
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, 8am - 5pm Monday through Friday
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Job Responsibilities:
- Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies.
- Enter authorization and pre-determination requests into information system according to Network Health policies, procedures and desk references
- Assign case and condition candidates received via referrals 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, or 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
- 2 years of health care experience in clinical or insurance setting required
Network Health is an Equal Opportunity Employer
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