Member Support Specialist II - DSNP

PacificSource Health Plans - Bend, OR

Full-time

Bend, 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, 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 fostering 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 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 using claims data and reports.
• Screen requests for appropriate referrals to case management from various 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 maintain confidentiality of protected health information.
• Assist members with referrals, scheduling appointments, and transportation to medical appointments.
• Support members with non-clinical needs during transitions and different phases of care.
• Manage mailing lists and outgoing mailings.

Requirements

• A minimum of three years of experience in community services or healthcare agencies focused on coordination services.
• High school diploma or equivalent required.
• Knowledge of medical terminology and proficient 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 accessing community resources and the healthcare system.

Nice-to-haves

• Experience in health insurance and delivering group presentations.