What are the responsibilities and job description for the Member Support Specialist II - Medicaid position at PacificSource Health Plans?
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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.
The Member Support Specialist will work as an integral part of the case management team to serve as a resource to members. The Specialist will work telephonically and in person to support members with complex psycho-social issues which create barriers to adherence with medical regimens and achievement of optimal health outcomes. (Examples may include activities such as assisting with arranging transportation, linking patients with community resources, etc.). Will assist with program development, and build effective member and provider relationships.
Essential Responsibilities:
- In coordination with the member’s case manager, develop and implement goals and/or plans tailored to assist members in navigating the complexities of the healthcare system.
- Educate members on understanding and working within the parameters of their benefit structure.
- Utilize motivational interviewing and patient-engagement techniques to support members in achieving optimal health outcomes by effectively utilizing their benefits.
- Identify community resources and make referrals to members as appropriate.
- Serve as liaison between members and providers/agencies.
- Identify members for coordination and case management services through a variety of methods, including claims data and reports.
- Screen requests to identify appropriate referrals to case management from multiple internal and external sources.
- Work collaboratively with the case management team to help facilitate case management process. Participate in case management/care coordination meetings.
- Ensure compliance with applicable state and federal regulations and guidelines in day-to-day activities, including maintaining HIPAA standards and confidentiality of protected health information. Ensure accurate and timely documentation.
- Assist members with referrals, scheduling appointments and ensuring transportation to medical appointments is available.
- Assist members with non-clinical needs for transitions and different phases of care.
- Manage mailing lists and outgoing mailings.
Supporting Responsibilities:
- Assist with the development of departmental procedures, reports and projects.
- Assist care management to meet quality measures as outlined by government regulations.
- Enter and collate data: prepare reports as assigned.
- Participate in team, department, company, and community-related committees as requested.
- Make presentations to small groups. Actively participates in quality improvement initiatives.
- Meet department and company performance and attendance expectations.
- Perform other duties as assigned.
Work Experience: 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.
Education, Certificates, Licenses: High school diploma or equivalent required.
Knowledge: Medical terminology. Proficient in Microsoft Office, including Word, Excel, PowerPoint, Medical management software (e.g CaseTrakker Dynamo). Excellent verbal and written communication skills and is able to work independently as well as to work effectively on a team. Good working knowledge of how to access community resources and healthcare system.
Competencies:
Building Customer Loyalty
Building Strategic Work Relationships
Contributing to Team Success
Planning and Organizing
Continuous Improvement
Adaptability
Building Trust
Work Standards
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 20% of the time.
Skills:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to foster individual, team and company growth.
- We actively participate in efforts to improve our many communities-internally and externally.
- We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
- We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
