Remote Care Coordination Specialist

The Elevance Health Companies, Inc.; Nashville (TN); Remote; USD 42,000 - 58,000; Full time

Job summary

The Elevance Health Companies, Inc. in Nashville, Tennessee is seeking an Outreach Care Specialist to support member care coordination in a virtual, full-time role with required in-person training.

The position emphasizes flexible scheduling within CST/EST time zones and a hybrid/virtual work policy. You will initiate referrals, coordinate follow-up, assess compliance, identify barriers, and support quality goals.

Qualifications

• Requires a H.S. diploma or equivalent and a minimum of 1 year related experience; or any combination of education and experience which would provide an equivalent background.
• BS/BA degree preferred; PTA/OTA with at least one year of experience preferred.
• Minimum 1 year of DME ordering experience preferred; experience dealing with vendors and insurance companies preferred.

Responsibilities

• Initiates and manages clinical referrals and orders including but not limited to: Specialists, Labs and Imaging Centers.
• Coordinates follow-up care plan needs for members by scheduling appointments or enrolling members in programs.
• Assesses member compliance with medical treatment plans via telephone or through on-site visits.
• Identifies barriers to plan compliance and coordinates resolutions.
• Identifies opportunities that impact quality goals and recommends process improvements.
• Medical record audit support to support HEDIS/Star program goals
• Recommends treatment plan modifications and determines need for additional services, in conjunction with case management and provider.
• Coordinates identification of and referral to local, state or federally funded programs.
• Recommends treatment plan modifications and determines need for additional services, in conjunction with case management and provider.
• Coaches members on ways to reduce health risks.
• Prepares reports to document case and compliance updates.
• Participates in cross-functional teams on projects, initiatives, and process improvement activities.
• Establishes and maintains relationships with agencies identified in appropriate contract.

Skills

Communication

Multitasking

Time management

Bilingual

Education

HS diploma or equivalent

BS/BA degree preferred

PTA/OTA experience preferred

DME ordering experience preferred

Tools

Microsoft Office proficiency

EMR/Care management systems

Job description

The Elevance Health Companies, Inc. in Nashville, Tennessee is seeking an Outreach Care Specialist to support member care coordination in a virtual, full-time role with required in-person training.

The position emphasizes flexible scheduling within CST/EST time zones and a hybrid/virtual work policy. You will initiate referrals, coordinate follow-up, assess compliance, identify barriers, and support quality goals.