Population Health Specialist II

Network Health WI; Menasha (WI); Remote; USD 50,000 - 70,000; Full time

Job summary

A leading health organization is seeking a Population Health Specialist II to manage authorization requests and support various departments. This role involves member interaction, operational support, and compliance monitoring. The position allows for remote work within Wisconsin, with occasional travel to the corporate office.

Qualifications

• Two years of healthcare experience in a clinical or insurance setting required.
• Intermediate Microsoft Office skills.

Responsibilities

• Process authorization requests and triage authorization workflow.
• Interact with members and providers regarding authorizations and case management.
• Assist with mentoring new employees.

Skills

Healthcare Experience

Microsoft Office

Communication

Education

High School Diploma

Job description

Join to apply for the Population Health Specialist II role at Network Health WI.

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 process. This role 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. The Population Health Specialist II may also be responsible for various outbound member calls, including new welcome calls and service recovery opportunities.

Job Responsibilities

1. Demonstrate commitment and behavior aligned with the philosophy, mission, values, and vision of Network Health.
2. Appropriately apply all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies.
3. Enter authorization/pre-determination requests into the information system according to Network Health policies, procedures, and desk references. Authorization requests include services listed on the NHP/NHIC/NHAS list requiring prior authorization.
4. Assign case and condition candidates received via referrals/triggers to appropriate Care or Condition Management Coordinator.
5. Interact with members, practitioners/providers, or other entities via telephone calls, faxes, emails, or letters related to authorizations, case management, claims, and benefit inquiries.
6. Collect member or provider-specific information telephonically or electronically as requested.
7. Assist in mentoring new employees as needed.
8. Assist with other non-clinical projects and tasks when needed.
9. Perform other duties as assigned.

Job Requirements

• High School Diploma
• Two (2) years of healthcare experience in a clinical or insurance setting required
• Intermediate Microsoft Office skills
• Proficient computer and phone/faxing skills

This position is eligible to work remotely from your home office in Wisconsin. Occasional travel to the corporate office in Menasha, WI, may be required.

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages, and retains a diverse workforce.