Member Engagement Specialist

Pacific Health Group•Tyler Heights, WV

1d•$21 - $24

About The Position

The Member Engagement Specialist is the first point of contact for prospective Pacific Health Group members. The role conducts outbound outreach, explains available programs, facilitates enrollment, assists with Medi-Cal and public benefits applications when appropriate, and supports a smooth transition into ongoing services. Specialists build rapport with referred individuals, coordinate justice-involved and community-based warm handoffs, and connect enrolled members with Lead Care Managers. The position also maintains relationships with referral sources, documents interactions in accordance with HIPAA, PHG policies, CalAIM requirements, and health plan standards, and represents Pacific Health Group at community outreach events. Success requires strong communication, compassion, persistence, organization, and a commitment to improving access to care for underserved populations.

Requirements

High school diploma or equivalent.
Minimum of 1–2 years of experience in customer service, healthcare, member services, outreach, care coordination, insurance enrollment, call center operations, or a related field.
Excellent verbal communication and interpersonal skills.
Comfort spending the majority of the workday conducting outbound member calls.
Strong organizational skills and ability to manage multiple priorities.
Basic computer proficiency and ability to quickly learn new software platforms.
Valid driver's license and reliable transportation for occasional community events or meetings.

Nice To Haves

Associate's or Bachelor's degree in social work, public health, human services, healthcare administration, or a related field.
Experience working with Medi-Cal populations.
Knowledge of Enhanced Care Management (ECM), Community Supports (CS), CalAIM, or managed care.
Experience assisting with Medi-Cal or BenefitsCal applications.
Bilingual in English and Spanish, Vietnamese, Mandarin, Russian, or another language commonly spoken within the communities served.

Responsibilities

Conduct outbound telephone outreach to prospective members referred by health plans, providers, hospitals, correctional facilities, community organizations, and other sources.
Educate prospective members about Enhanced Care Management (ECM) and other available Pacific Health Group services.
Build rapport and trust through compassionate, professional communication.
Complete member enrollments and obtain required consents and documentation.
Conduct follow-up outreach to members who are difficult to reach or have not enrolled.
Coordinate justice-involved member referrals and warm handoffs to support transitions into ECM services.
Track referrals from receipt through enrollment and ensure timely follow-up.
Assist members with Medi-Cal applications, renewals, BenefitsCal applications, and other public benefit navigation when appropriate.
Educate members about healthcare, behavioral health, and community resources.
Identify and work collaboratively to address barriers to enrollment or engagement.
Answer questions about program eligibility, services, and next steps.
Escalate urgent concerns or barriers to leadership and care teams when appropriate.
Collaborate with Lead Care Managers to support transitions into ongoing care management.
Coordinate with health plans, providers, hospitals, correctional facilities, community organizations, and referral partners.
Ensure required documentation is complete before transferring members into active care management.
Communicate enrollment status to referral sources when appropriate.
Maintain accurate, timely, HIPAA-compliant, complete, and audit-ready documentation of member interactions and enrollment.
Maintain confidentiality and comply with federal, state, and organizational requirements.
Represent Pacific Health Group at health fairs, community events, provider meetings, and other outreach opportunities as assigned.
Promote awareness of ECM, Community Supports, and Pacific Health Group services.
Build and maintain positive relationships with community organizations and referral partners.
Assist with outreach initiatives to increase awareness and generate member referrals.