Network 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.