Member Engagement Specialist

Pacific Health Group•Tulare, CA

4h•$22 - $25•Hybrid

About The Position

The Member Engagement Specialist is a high-impact, community-facing role responsible for driving member growth and engagement across Pacific Health Group’s Enhanced Care Management (ECM) and Community Supports programs. The majority of this role is spent in the field—building relationships, generating referrals, and connecting individuals to the services that can change their lives.This position is the front door to Pacific Health Group for many of our members. The Member Engagement Specialist actively canvasses community settings—shelters, clinics, hospitals, food distribution sites, encampments, resource fairs, and partner agency offices—to identify individuals who qualify for PHG services and support them through enrollment and initial engagement. This is not a desk job; it is a boots-on-the-ground role that requires initiative, resilience, and genuine compassion for people navigating complex life circumstances. In addition to community-based outreach, the Member Engagement Specialist conducts assessments, facilitates referrals, and ensures accurate, compliant documentation. They serve as a critical bridge between the community and PHG’s care teams, helping reduce barriers to care, strengthen continuity of services, and improve health outcomes for Medi-Cal populations served through Santa Clara Family Health Plan. What Success Looks Like: A successful Member Engagement Specialist consistently generates new member referrals through proactive community presence, maintains strong relationships with partner organizations, and ensures every individual they meet feels welcomed and supported in connecting to PHG services.

Requirements

High school diploma or equivalent; associate’s or bachelor’s degree in social work, public health, human services, or related field preferred.
Minimum 1–2 years of experience in community outreach, street outreach, member engagement, or a related community-facing role within healthcare or social services.
Demonstrated ability to build relationships and trust with individuals experiencing homelessness, mental health challenges, substance use disorders, and other complex needs.
Comfort and confidence engaging individuals in non-traditional settings such as encampments, shelters, emergency rooms, and on the street.
Valid California driver’s license, reliable transportation, and willingness to travel throughout Santa Clara County daily.
Bilingual in English and Spanish, Vietnamese, or Mandarin strongly preferred.
Strong interpersonal and rapport-building skills with diverse populations.
Self-motivated and able to work independently in the field with minimal supervision.
Excellent organizational skills with the ability to track outreach activities, referrals, and follow-ups.
Cultural humility and trauma-informed communication approach.
Proficiency with electronic health records, care management platforms, and basic computer applications.
Ability to remain calm, compassionate, and professional in challenging or unpredictable community environments.
Team-oriented with strong collaboration skills across departments and with external partners.
This role requires regular travel throughout Santa Clara County, including driving to community sites, walking through various terrain, and spending extended periods outdoors in all weather conditions.
Ability to stand, walk, and move through community settings for extended periods.
Occasional lifting up to 25 lbs (outreach materials, supplies).

Nice To Haves

Experience working with Medi-Cal populations, managed care, or safety-net healthcare systems preferred.

Responsibilities

Proactively conduct street-level and site-based outreach across Santa Clara County to identify, engage, and enroll eligible members into ECM and Community Supports programs.
Build and maintain a consistent presence at community locations including shelters, transitional housing sites, hospitals, emergency departments, behavioral health clinics, food pantries, resource fairs, and encampments.
Develop and nurture referral relationships with community-based organizations (CBOs), social workers, discharge planners, clinic staff, law enforcement outreach teams, and other partners who can refer members to PHG services.
Represent Pacific Health Group at community events, health fairs, partner meetings, and coalition gatherings to promote services and expand referral pipelines.
Distribute PHG outreach and marketing materials to community partners, agencies, and public-facing locations to increase awareness of available services.
Conduct warm handoffs by introducing prospective members to Lead Care Managers and care teams, supporting a seamless transition from outreach to enrollment.
Track outreach activities, referral sources, and conversion outcomes to support data- driven outreach strategy and continuous improvement.
Identify gaps in community awareness of PHG services and recommend targeted outreach strategies to reach underserved populations.
Conduct initial risk assessments in the field and office settings to understand each member’s health, behavioral health, and social needs.
Review medical and social histories to determine eligibility for programs such as Enhanced Care Management (ECM) and Community Supports.
Coordinate with Lead Care Managers and interdisciplinary teams to initiate and support individualized care plans.
Ensure timely, thorough documentation in PHG systems in accordance with program and compliance requirements.
Facilitate referrals to internal programs and external providers, ensuring timely access to care and community resources.
Communicate with clinics, specialists, hospitals, and community-based organizations to support successful member engagement.
Track referral outcomes and close referral loops, identifying and addressing barriers to access as needed.
Serve as a point of contact for assigned members via phone, text, and virtual check-ins.
Conduct follow-up outreach to support continuity of care and ongoing engagement.
Collaborate with care managers, healthcare providers, and family members to address challenges and support member goals.
Maintain accurate, timely, and HIPAA-compliant documentation across PHG systems for all outreach contacts, referrals, and member interactions.
Support quality assurance efforts by auditing data for completeness and participating in continuous quality improvement initiatives.
Collect and share member feedback to inform service enhancements and outreach workflow improvements.
Conduct structured re-engagement efforts for inactive members via phone, text, virtual, and in-person outreach.
Support enrollment, scheduling of assessments, and collection of required documentation.
Support appropriate disenrollment processes in alignment with health plan requirements and documentation standards.