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Outreach Care Specialist I/II/...


Job Summary

Fellsmere, FL
Other/Not Classified
Job Type
Full Time
Career Level
Experienced (Non-Manager)
Job Reference Code

Outreach Care Specialist I/II/Sr- Central Florida/Treasure Coast- PS1700

About the Job


Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

Outreach Care Specialist I/II/Sr:

Responsible for ensuring that appropriate member treatment plans are followed on less complex cases and for proactively identifying ways to improve the health of our members and meet quality goals.

This position will require travel within Central Florida or the Palm Beach County/Treasure Coast area

Level I/II:

Primary duties may include, but are not limited to:

  • 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.
  • 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.
  • Coaches members on ways to reduce health risks.
  • Prepares reports to document case and compliance updates.
  • Establishes and maintains relationships with agencies identified in appropriate contract.

Level Sr:

Primary duties may include, but are not limited to:

  • Locate and engage members in the community (i.e. Hospitals, Assisted Living Facilities (ALF's), Crisis stabilization Units (CSU), Substance Abuse Treatment programs, etc.) in efforts to engage them in care.
  • Gathers clinical information regarding case; determines appropriate areas for referrals, and reaching systems such as Claims/Pharmacy, Florida resident database, and the justice systems to locate members and conduct Health Risk Assessments in the field.
  • Collaborates with external community-based organizations to facilitate and coordinate care (i.e. Ryan White, housing programs, legal aid, and/or other community based organizations that provide services to our members).
  • Maintains and updates tracking databases; prepares reports and documents all actions; responds to requests, calls or correspondence within scope.
  • Assesses member compliance with medical and behavioral treatment through appointment completion rates.
  • Decreases ER/Hospital Admissions through engagement.
  • Coordinates identification of and referral to local, state or federally funded programs.
  • Establishes and maintains relationships with Hospitals, Assisted Living Facilities (ALF'S), and Crisis stabilization Units (CSU).
  • Provides education to members regarding all services available through the plan.
  • Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information.
  • Coordinates with CM and participates in Interdisciplinary Care Team (ICT) Meetings.

*Manager will determine level based upon the selected applicant's skillset relative to the qualifications listed for this position.*



  • High School Diploma/GED equivalent,
  • 1-4 years of related experience; or any combination of education and experience which would provide an equivalent background.
  • Certified nurse assistant or certified medical assistant and/or BS/BA degree in related field preferred.
  • Bilingual candidates preferred.
  • Case Management and/or Managed Care experience preferred.
  • Experience with one or more of the following populations a plus: HIV/AIDS, Behavioral Health, Substance Use Disorders.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.


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