Member Support Specialist II - DSNP

PacificSource Health Plans - Boise, ID

Full-time

Boise, ID

Insurance Carriers and Related Activities

About the position

The Member Support Specialist II will play a crucial role in the case management team at PacificSource, assisting members with complex psycho-social issues that hinder their healthcare adherence and optimal health outcomes. This position involves telephonic and in-person support, program development, and building effective relationships with members and providers to facilitate access to quality, affordable care.

Responsibilities

• Develop and implement goals and/or plans tailored to assist members in navigating the healthcare system.
• Educate members on understanding and working within their benefit structure.
• Utilize motivational interviewing and patient-engagement techniques to support members in achieving optimal health outcomes.
• Identify community resources and make appropriate referrals to members.
• Serve as a liaison between members and providers/agencies.
• Identify members for coordination and case management services through various methods, including claims data and reports.
• Screen requests to identify appropriate referrals to case management from multiple sources.
• Collaborate with the case management team to facilitate the case management process and participate in related meetings.
• Ensure compliance with state and federal regulations, including HIPAA standards and confidentiality.
• Assist members with referrals, scheduling appointments, and ensuring transportation to medical appointments.
• Manage mailing lists and outgoing mailings.
• Assist with the development of departmental procedures, reports, and projects.
• Enter and collate data, preparing reports as assigned.
• Participate in team, department, company, and community-related committees as requested.
• Make presentations to small groups and participate in quality improvement initiatives.
• Meet department and company performance and attendance expectations.

Requirements

• A minimum of three years of experience in community services or healthcare agencies focused on coordination services required.
• High school diploma or equivalent required.
• Knowledge of medical terminology and proficiency in Microsoft Office (Word, Excel, PowerPoint) and medical management software (e.g., CaseTrakker Dynamo).
• Excellent verbal and written communication skills, with the ability to work independently and as part of a team.
• Good working knowledge of how to access community resources and the healthcare system.

Nice-to-haves

• Experience in health insurance and delivering group presentations preferred.