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PacificSource Health Plans - Springfield, OR
posted 3 months ago
About the position
The Member Support Specialist II - Medicaid at PacificSource plays a crucial role in assisting members with complex psycho-social issues that hinder their healthcare adherence and optimal health outcomes. This position involves working closely with case management teams to develop personalized plans, educate members about their benefits, and connect them with community resources. The Specialist will also engage in program development and foster strong relationships with both members and providers.
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 referrals to members as appropriate.
- 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.
- Assist members with referrals, scheduling appointments, and transportation to medical appointments.
- Assist members with non-clinical needs during transitions and different phases of care.
- Manage mailing lists and outgoing mailings.
- Assist with the development of departmental procedures, reports, and projects.
- Enter and collate data and prepare 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.
- Experience in health insurance and delivering group presentations preferred.
- 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, able to work independently and effectively in 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.
Benefits
- Flexible telecommute policy
- Medical, vision, and dental insurance
- Incentive program
- Paid time off and holidays
- 401(k) plan
- Volunteer opportunities
- Tuition reimbursement and training
- Life insurance
- Flexible spending account options
