Job Summary:
The Prevention Health Specialist is responsible for assisting and educating both members and providers on appropriate preventive health services to ensure compliance to state and federal guidelines and improved health outcomes.
Essential Functions:
- Ensure that members eligible for Medicaid benefits receive outreach for informing, screening, tracking, diagnostic and treatment services available under the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit
- Responsible for execution, monitoring and reporting of Quality or Preventive Health Programs and strategies (i.e., School Based Health Centers, Telehealth), including supporting members with educational materials according to clinical best practice guidance
- Participate in quarterly market Quality Improvement and population health management workgroups
- Facilitate completion of the annual evaluation report for assigned market/product
- Attend telephonic Health Partner meetings with top providers; engage in population and rural provider strategy
- Telephonically contact eligible members and providers to discuss all preventive care needs, benefits and their current gaps in care
- Ensure that contractual/regulatory requirements for prevention services are met
- Collaborate with enterprise quality for all prevention services, analysis of data and reporting
- Be fully versed in individual state clinical/programmatic contract management requirements
- Collaborate closely with members’ assigned case managers to coordinate care and programs
- Prepare weekly, monthly, quarterly and annual reports of outreach activities
- Perform any other job duties as assigned
Education and Experience:
- Bachelor’s degree in business or health care field or equivalent years of relevant work experience is required
- Minimum of three (3) years of experience in healthcare, community health or related field is required
- Managed care organization experience is preferred
- Experience working with data and data analytics is preferred
Competencies, Knowledge and Skills:
- Proficient in Microsoft Office including PowerPoint, Word and Excel
- Ability to communicate and interact with individuals at varying skill levels, educational and cultural backgrounds
- Familiarity of state and federal healthcare regulations and environment
- Data analysis and trending skills
- Strong presentation skills
- Excellent time management skills and ability to manage and meet workloads and deadlines
- Ability to work independently and within a team environment
- Critical listening and thinking skills
- Proper grammar usage and phone etiquette
- Customer service oriented
- Ability to be flexible
Licensure and Certification:
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
- Occasional evening and weekend work to meet the needs of the business
Compensation Range:
$52,400.00 - $83,900.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
