PacificSource Health Plans - Springfield, OR
posted 26 days ago
Full-time - Entry Level
Springfield, OR
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 Health Plans, assisting members with complex psycho-social issues that hinder their healthcare adherence and optimal health outcomes. This position involves both telephonic and in-person support, focusing on resource linkage, program development, and building effective relationships with members and providers.
Responsibilities
- Develop and implement tailored goals and plans to assist members in navigating the healthcare system.
- Educate members on their benefit structure and how to utilize it effectively.
- Utilize motivational interviewing and patient-engagement techniques to support members' health outcomes.
- Identify community resources and make appropriate referrals to members.
- Serve as a liaison between members and providers/agencies.
- Screen requests to identify appropriate referrals to case management services.
- Collaborate with the case management team to facilitate the case management process.
- Participate in case management and care coordination meetings.
- Ensure compliance with state and federal regulations, including HIPAA standards.
- Maintain accurate and timely documentation of member interactions.
- Assist members with referrals, scheduling appointments, and transportation to medical appointments.
- Manage mailing lists and outgoing mailings.
- Assist with departmental procedures, reports, and projects.
- Participate in quality improvement initiatives and meet performance 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 proficient in Microsoft Office (Word, Excel, PowerPoint).
- Excellent verbal and written communication skills.
- Good working knowledge of community resources and the healthcare system.
Nice-to-haves
- Experience in health insurance and delivering group presentations preferred.
Benefits
- Health insurance coverage
- 401k retirement savings plan
- Paid holidays
- Flexible scheduling options
- Professional development opportunities
