Member Support Specialist Team Lead - DSNP

PacificSource Health Plans - Salem, OR

Full-time - Mid Level

Remote - Salem, OR

1,001-5,000 employees

Insurance Carriers and Related Activities

About the position

The Member Support Specialist Team Lead is responsible for supervising and guiding the Case Management Member Support Services team at PacificSource. This role involves hiring, training, coaching, and evaluating team performance while ensuring compliance with company policies and quality standards. The Team Lead will also assist in resolving member and provider issues, develop departmental metrics, and foster a collaborative environment to enhance service delivery to members navigating healthcare and social systems.

Responsibilities

• Supervise and provide guidance to Case Management Member Support Services team members.
• Responsible for hiring, training, coaching, counseling, and evaluating team member performance.
• Assist in resolution of provider/community partner and member issues referred to Case Management Department services.
• Evaluate performance of team members and analyze performance reports to determine training needs.
• Assist team in developing and implementing goals to help members navigate healthcare and social systems.
• Create, evaluate, and track departmental metrics to measure performance.
• Oversee team in creating exceptional customer communication networks and educational opportunities.
• Utilize motivational interviewing and engagement techniques to support customers in utilizing resources.
• Serve as liaison between members, providers/agencies, and community partners.
• Identify members for coordination and case management services through various methods.
• Screen requests to identify appropriate referrals to case management.
• Collaborate with the case management team to facilitate processes and meetings.
• Participate in the development and maintenance of the Case Management Department Manual and policies.
• Perform education and introductory meetings for providers/community partners and staff.
• Investigate and settle issues not resolvable by staff and relay information for dispute resolution.
• Ensure compliance with state and federal regulations and maintain HIPAA standards.

Requirements

• A minimum of four years of experience in community services or healthcare agencies focused on coordination services required.
• Supervisory experience preferred.
• High school diploma or equivalent required.
• Personal Health Navigator (PHN) certification required within two years of hire or promotion.
• Excellent verbal and written communication skills.
• Ability to work independently and effectively on a team.
• Proficient in Microsoft Office, including Word, Excel, PowerPoint, and medical management software.
• Good working knowledge of community resources and healthcare systems.
• Basic math skills including percentages, ratios, graphing, and spreadsheet skills.

Nice-to-haves

• Experience in healthcare management or case management services.
• Knowledge of Medicaid processes and regulations.

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