Population Health Specialist I

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

Job Responsibilities:

• Demonstrate commitment and behavior aligned with the philosophy, mission, values and vision of Network Health
• 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
• One (1) year of health care experience in clinical or insurance setting preferred.

This position is eligible to work remote out of your home office in the state of Wisconsin. Occasional travel to the corporate office (Menasha, WI) is required for the role.

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce.