Member Support Specialist II

Join PacificSource and help our members access quality, affordable care!

• →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.

Building Customer Loyalty

Building Strategic Work Relationships

Contributing to Team Success

Planning and Organizing

Continuous Improvement

Adaptability

Building Trust

Work Standards

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.