Member Support Specialist

PacificSource • Bend, OR

18h • Hybrid

About The Position

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.

Requirements

• A minimum of three years of experience in community services or healthcare agencies focused on coordination services required.
• 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.
• High school diploma or equivalent required.

Nice To Haves

• Experience in health insurance and delivering group presentations preferred.

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.
• 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.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED