• Job Description

  Req#: POPUL002265
  The Population Health Specialist II provides operational support for the Case, Condition Management, Quality, Wellness, Pharmacy, Government Relations, and Utilization Management Departments including requesting and extracting medical records and provider outreach for HEDIS, Health Risk Assessments, Primary Care Provider Attributions, and CIOX medical records. This role assists with supporting and monitoring compliance with CMS federal regulatory and NCQA standards related to the authorization process. The Population Health specialist II may also be responsible for various outbound member calls, including new welcome calls, service recovery opportunities, etc.
  
  Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day.
  
  Hours: 1.0 FTE, 40 hours per week, 7:30am - 5pm Monday through Friday
  
  Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.
  
  Job Responsibilities:
  
  • Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies.
  • Enter authorization and pre-determination requests into information system according to Network Health policies, procedures and desk references
  • Assign case and condition candidates received via referrals 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, or 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 required
  • 2+ years of health care experience in clinical or insurance setting required
  
  Network Health is an Equal Opportunity Employer
  
  Equal Opportunity Employer
  This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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