Member Support Specialist II - Medicaid

PacificSource Health Plans - Salem, OR

Full-time

Salem, OR

Insurance Carriers and Related Activities

About the position

The Member Support Specialist II - Medicaid plays a crucial role in the case management team at PacificSource Health Plans, focusing on assisting members with complex psycho-social issues that hinder their healthcare access and adherence to medical regimens. This position involves both telephonic and in-person support, aiming to help members navigate the healthcare system effectively and achieve optimal health outcomes.

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.
• Assist members with referrals, scheduling appointments, and transportation to medical appointments.
• Manage mailing lists and outgoing mailings.
• Assist with 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.
• Actively participate in quality improvement initiatives.

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.
• Proficient in Microsoft Office, including Word, Excel, PowerPoint, and medical management software (e.g., CaseTrakker Dynamo).
• Excellent verbal and written communication skills.
• Ability to work independently and effectively on a team.
• Good working knowledge of community resources and the healthcare system.

Nice-to-haves

• Experience in health insurance and delivering group presentations preferred.