Anthem Outreach Care Specialist - El Paso, TX - 122155 in El Paso, Texas

*/ Your Talent. Our Vision. / At Amerigroup , a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s 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. *

  • Outreach Care Specialist *

This is an office based position in the Texas Health Plan of Amerigroup, El Paso office. You must be able to work in the office daily, 8:00AM - 5:00PM. This Outreach Care Specialist supports the LTSS (long term services and supports) dept.

Responsible for new member outreach and letter creation and 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.

Primary duties may include, but are not limited to:

  • Coordinates follow-up care plan needs for members.

  • Assesses member compliance with medical treatment plans via telephone.

  • Identifies barriers to plan compliance and coordinates resolutions.

  • Identifies opportunities that impact quality goals and recommends process improvements.

  • Performs claims research and authorization extensions and verifications

  • 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.

  • Prepares reports to document case and compliance updates.

  • Establishes and maintains relationships with agencies identified in appropriate contract.


  • High school diploma

  • One year of related experience; or any combination of education and experience, which would provide an equivalent background. "Related experience" would be experience with in a hospital or doctor's office; pre-cert experience, health insurance experience, claims/billing experience, or similar.

  • Certified nurse assistant or certified medical assistant and/or BS/BA degree in a related field preferred.

  • Bilingual candidates preferred.

  • Experience working with the Star Plus program/LTSS program preferred.

  • Computer skills: MS Word, Outlook, Excel

  • Experience making outbound calls in a customer service environment a plus.

  • Must be able to communicate clearly and maintain a calm and professional demeanor at all times.

  • Excellent organization skills and ability to set priorities.

/ Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran. /

Job Medical

Title: Outreach Care Specialist - El Paso, TX - 122155

Location: TX-El Paso

Requisition ID: 122155