Member Engagement Specialist

Pacific Health Group•State-Wide, WA

8h•Onsite

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 BenefitsCal applications when appropriate, and supports a smooth transition into services. Specialists build rapport with prospective members referred by health plans, providers, hospitals, correctional facilities, and community organizations, and coordinate warm handoffs—particularly for justice-involved members—so members can connect with Lead Care Managers for ongoing care coordination. The position also helps members navigate healthcare and community resources, identifies and works to address barriers to enrollment, maintains relationships with referral sources, and represents Pacific Health Group at community events. Accurate, timely, confidential, and audit-ready documentation is required in accordance with PHG policies, CalAIM requirements, health plan standards, and applicable privacy and compliance requirements. The work is primarily office- and telephone-based, with occasional travel to outreach events and meetings. Success in this role requires compassionate and persistent communication, strong organization, cultural sensitivity, and a commitment to improving access to care for underserved populations.

Requirements

High school diploma or equivalent.
At least 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 with conducting outbound member calls for most of the workday.
Strong organizational skills and ability to manage multiple priorities.
Basic computer proficiency and ability to learn new software platforms.
Valid driver's license and reliable transportation for occasional community events or meetings.
Ability to occasionally travel throughout assigned service areas for outreach events and meetings.
Ability to lift up to 25 pounds of outreach materials or supplies as needed.

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.
Exceptional customer service and member engagement, active listening, rapport-building, compassion, empathy, professionalism, cultural sensitivity, time management, problem-solving, critical thinking, accurate documentation, ability to work independently and collaboratively, and adaptability in a fast-paced environment.

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 Pacific Health Group services.
Build rapport and trust through compassionate, professional communication; complete 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 referrals and warm handoffs with correctional facilities, reentry programs, probation departments, health plans, and community partners.
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; answer questions about eligibility, services, and next steps.
Identify barriers to enrollment or engagement and work collaboratively to address them; escalate urgent concerns or barriers when appropriate.
Collaborate with Lead Care Managers and external partners to support transitions into ongoing care management.
Ensure required documentation is complete before transferring members into active care management, and communicate enrollment status to referral sources when appropriate.
Maintain accurate, timely, confidential, HIPAA-compliant, and audit-ready documentation in accordance with PHG policies, CalAIM requirements, health plan standards, and applicable compliance requirements.
Represent Pacific Health Group at health fairs, community events, provider meetings, and other assigned outreach opportunities.
Promote PHG services and build positive relationships with community organizations and referral partners.
Assist with outreach initiatives to increase awareness of services and generate member referrals.