What are the responsibilities and job description for the Member Support Specialist I position at PacificSource Health Plans?
Looking for a way to make an impact and help people?
Join PacificSource and help our members access quality, affordable care!
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.
Position Overview: Work as an integral part of the case management team to serve as a resource to members and community providers/partners. 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. Assist with program development, team processes, as well as build effective member, provider and community partner relationships.
Essential Responsibilities:
- Utilize motivational interviewing and patient-engagement techniques to support members in achieving optimal health outcomes by effectively utilizing their benefits.
- Effectively handle incoming department telephone calls and emails.
- Identify member needs and refer to the appropriate internal resources.
- Screen case management referral requests from multiple internal and external sources.
- Assist case management team to facilitate the case management process.
- Create events in Medical Management Platform.
- Assist with quality measures.
- Assist with member-focused meetings and complete associated administrative tasks as indicated.
- Assist with other administrative duties as appropriate, including meeting minutes.
- Ensure compliance with applicable state and federal regulations and guidelines in day-to-day activities.
- Ensure accurate and timely electronic and documentation within multiple software programs.
Supporting Responsibilities:
- Manage electronic mailing lists, group phone queue and outgoing mailings.
- Participate in team, department, company, and community-related projects/committees as requested.
- Meets department and company performance and attendance expectations.
- Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
- Perform other duties as assigned.
Work Experience: Requires a minimum of one year of experience in community service or healthcare agencies providing coordination of services. Call center experience preferred.
Education, Certificates, Licenses: High school diploma 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 ability 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 25% of the time. May be required to use personal vehicle for work-related purposes and to meet with members in the community setting. May need to work outside normal work hours.
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.