D-SNP Care Coordination Specialist - Member Outreach

Our Client, an IT Services and Consultant company, is looking for a D-SNP Care Coordination Specialist - Member Outreach for their Remote location.

Responsibilities:

• Responsible for supporting the health, wellness, care coordination, and engagement needs of Dual Eligible Special Needs Plan (D-SNP) members through proactive outreach, care gap closure support, transition of care follow-up, provider collaboration, and operational support. Partners with Case Management, Utilization Management, Quality, and Care Coordination teams to help ensure members receive timely preventive, primary, specialty, behavioral health, and post-discharge services in alignment with CMS D-SNP Model of Care requirements.
• Conduct proactive outreach to D-SNP members to support engagement in care management, care coordination, health improvement programs, and member retention activities.
• Perform post-discharge and transition of care outreach following hospital, emergency department, skilled nursing facility, or other care setting events to encourage timely PCP, specialist, and behavioral health follow-up.
• Support scheduling, appointment coordination, transportation assistance, benefit education, and connection to internal or community-based resources to help reduce barriers to care.
• Conduct outreach for open HEDIS, Stars, annual wellness visit, chronic condition, medication adherence, health risk assessment, and other quality-related care gaps; document outreach attempts, outcomes, and interventions.
• Coordinate with providers, facilities, members, caregivers, Medicaid resources, community-based organizations, and internal care teams to support continuity of care and closure of identified needs.
• Serve as an operational liaison among providers, members, Case Management, Utilization Management, Quality, Care Coordination, and other internal business partners.
• Support Case Managers through referral management, work queue maintenance, documentation support, correspondence tracking, interdisciplinary care team coordination, and care plan follow-up activities.
• Monitor workflows, identify recurring process issues, recommend operational improvements, and support departmental projects, testing, implementation activities, reporting, audits, quality reviews, and corrective action efforts.
• Maintain accurate and timely documentation of outreach, member interactions, operational activities, and outcomes in accordance with CMS, and organizational requirements.
• Maintain a non-clinical role by facilitating engagement, coordinating services, identifying barriers, and escalating clinical concerns, urgent health needs, social determinants of health issues, or potential safety concerns to appropriately licensed clinical staff.

Requirements:

• Years of Experience: 3 Years of Experience

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities