Population Health Specialist II
Company: Network Health
Location: Menasha
Posted on: April 20, 2024
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Job Description:
DescriptionNetwork Health's success is rooted in its mission to
create healthy and strong Wisconsin communities. It drives the
decisions we make, including the people we choose to join our
growing team. Network Health is seeking a Population Health
Specialist II. This individual will process Network Health
(NHIC/NHP/NHAS) authorization requests in accordance with
established guidelines and triages authorization workflow. Assists
with Case Management assignment of candidates and operational
support. Assists with supporting and monitoring compliance with
CMS/Federal regulatory and NCQA standards related to the
authorization processes.
Provides operational support for the Case, 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, and CIOX
medical records. The population health specialist II may also be
responsible for various outbound member calls, including by not
limited to new welcome calls, service recovery opportunities,
etc.
Job Responsibilities:
Job Requirements:
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) may be required for the role.
Network Health is an Equal Opportunity Employer. We encourage
applications from all backgrounds, communities and industries, and
are committed to having a team that is made up of diverse skills,
experiences and abilities. We are committed to equality and
diversity within Network Health.
Keywords: Network Health, Appleton , Population Health Specialist II, Healthcare , Menasha, Wisconsin
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