Population Health Specialist II
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![]() United States, Wisconsin, Menasha | |
![]() 1570 Midway Place (Show on map) | |
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Description
The Population Health Specialist II processes Network Health authorization requests in accordance with established guidelines and triages authorization workflow. This role assists with Case Management assignment of candidates and operational support, and with supporting and monitoring compliance with CMS/Federal regulatory and NCQA standards related to the authorization processes. This role 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 and service recovery opportunities. 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. We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. |