Outreach Representative - Remote

📋 Description

• • Serve as a liaison between members, the Health Plan, and state/federal regulators to ensure member needs are addressed and rights are upheld.
• • Conduct telephonic outreach to assess member needs, provide appointment scheduling assistance, and educate members on their healthcare rights and responsibilities.
• • Initiate proactive outreach campaigns focused on targeted preventive health initiatives, including educating members on the importance of preventive services.
• • Recruit, holistically assess, and enroll eligible members into Disease Management Programs based on clinical and behavioral indicators.
• • Identify opportunities for Care Management intervention and make appropriate referrals to internal or external resources.
• • Coordinate access to preventive health services by contacting members, healthcare providers, and community agencies.
• • Accurately track all member and provider interactions in designated computer systems to maintain compliance and support data collection efforts.
• • Participate in the development, evaluation, and improvement of outreach programs designed to effectively reach at-risk populations.
• • Demonstrate active listening and empathetic communication when interacting with members facing barriers such as transportation, childcare, financial hardship, or distrust of the healthcare system.
• • Apply sound judgment and discretion when resolving member concerns, navigating grievance and appeals processes, and representing member interests internally and externally.
• • Manage multiple tasks simultaneously with strong time management and prioritization skills while maintaining attention to detail.
• • Work independently and collaboratively as part of a team to achieve departmental and organizational goals.
• • Maintain strict adherence to HIPAA regulations, company privacy policies, and data security guidelines when handling sensitive member information.
• • Uphold the company’s Code of Business Conduct and comply with all federal, state, and local legal and ethical standards.
• • Perform duties with patience, cultural sensitivity, and professionalism when engaging with diverse populations, including Medicaid and Medicare beneficiaries.
• • Maintain accurate documentation and reporting standards for all outreach activities and member interactions.
• • Occasionally train or support peers in outreach protocols and system usage as needed.
• • Travel may be required up to 25% of the time for in-person coordination or community engagement activities.
• • Lift and carry items weighing up to 10 pounds regularly and up to 25 pounds occasionally as needed for office or field tasks.