Member Engagement Specialist bei Pacific Health Group

Description

Member Engagement Specialist

Location: California Residents Only
Employment Type: Hybrid
Compensation: $22.00–$25.00 per hour
Schedule: Monday through Friday | 8:30 AM – 5:00 PM
Reports To: Member Engagement Manager

About Pacific Health Group

At Pacific Health Group, we care deeply about the people and communities we serve. We meet individuals with kindness, respect, and understanding—listening first, honoring each person's journey, and offering support without judgment. Through compassionate, person-centered healthcare, behavioral health services, and social supports, we walk alongside people as they work toward healing, stability, and a healthier, more hopeful life.

Our Core Values 

• Speak with integrity—clear, respectful, and honest in every interaction.
• Embrace innovation by trying new ideas, learning quickly, and continuously improving care.
• Own our roles by staying accountable for outcomes and documenting accurately.
• Build genuine connections with members, families, teammates, and community partners through empathy and cultural sensitivity.
• Lead with trust by being consistent, transparent, and following through.
• Celebrate wins together by recognizing both individual and team achievements.
• Collaborate with purpose across departments, health plans, providers, and community organizations.
• Ask for support and offer support because thriving together is how we best serve our members.

Role Overview & Impact

• The Member Engagement Specialist serves as the first point of contact for prospective Pacific Health Group members. This role is responsible for conducting outbound outreach, educating eligible individuals about the various programs offered through Pacific Health Group, facilitating enrollments, assisting with Medi-Cal applications when appropriate, and ensuring a seamless transition into services.The primary responsibility of this position is conducting outbound phone outreach to members referred by health plans, providers, hospitals, correctional facilities, and community organizations. Member Engagement Specialists build rapport, educate members on available services, assist with enrollment, coordinate justice-involved and community-based warm handoffs, and ensure members are successfully connected with Lead Care Managers for ongoing care coordination.
• This role also supports Medi-Cal and BenefitsCal applications, maintains strong relationships with referral sources, and represents Pacific Health Group at community outreach events to promote awareness of available services.Success in this position requires exceptional communication skills, compassion, persistence, strong organizational abilities, and a genuine passion for improving access to care for underserved populations.

Why This Role Matters

• The Member Engagement Specialist plays a vital role in connecting vulnerable individuals with healthcare and social services that can improve their quality of life. As the first interaction many members have with Pacific Health Group, this role sets the tone for the member experience by creating trust, reducing barriers to care, and ensuring eligible individuals receive timely access to ECM, CS, and other services.

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.

Member Outreach & Enrollment

• Conduct outbound telephone outreach to prospective members referred by health plans, providers, hospitals, correctional facilities, community organizations, and other referral sources.
• Educate prospective members on Enhanced Care Management (ECM), and other available PHG services.
• Build rapport and establish trust with members 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 yet enrolled.
• Coordinate justice-involved member referrals and warm handoffs from correctional facilities, reentry programs, probation departments, health plans, and community partners to support successful transitions into ECM services.
• Track referral status from receipt through enrollment and ensure timely follow-up with all prospective members.

Member Support

• Assist members with Medi-Cal applications, renewals, BenefitsCal applications, and other public benefit navigation when appropriate.
• Educate members on available healthcare, behavioral health, and community resources.
• Identify barriers preventing enrollment or engagement and work collaboratively to resolve them.
• Answer member questions regarding program eligibility, services, and next steps.
• Escalate urgent concerns or barriers to leadership and care teams when appropriate.

Care Coordination

• Collaborate closely with Lead Care Managers to ensure smooth transitions from enrollment into ongoing care management.
• Coordinate with health plans, providers, hospitals, correctional facilities, community organizations, and referral partners to support member engagement.
• Ensure all required documentation is complete prior to transferring members into active care management.
• Maintain communication with referral sources regarding enrollment status when appropriate.

Documentation & Compliance

• Maintain accurate, timely, and HIPAA-compliant documentation of all member interactions.
• Complete enrollment documentation in accordance with PHG policies, CalAIM requirements, and health plan standards.
• Ensure documentation is complete, accurate, and audit-ready.
• Maintain confidentiality while adhering to all federal, state, and organizational compliance requirements.

Community Outreach

• Represent Pacific Health Group at health fairs, community events, provider meetings, and outreach opportunities as assigned.
• Promote awareness of ECM, Community Supports, and PHG services within the community.
• Build and maintain positive relationships with community organizations and referral partners.
• Assist with outreach initiatives designed to increase awareness of available services and generate member referrals.

Requirements

Qualifications

Required

• High school diploma or equivalent required.
• Associate's or Bachelor's degree in social work, public health, human services, healthcare administration, or a related field preferred.
• 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.
• Comfortable spending the majority of the workday conducting outbound member calls.
• Strong organizational skills with the ability to manage multiple priorities.
• Basic computer proficiency and ability to quickly learn new software platforms.
• Valid California driver's license and reliable transportation for occasional community events or meetings.

Preferred

• 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.

Skills & Competencies

• Exceptional customer service and member engagement
• Strong verbal communication and phone etiquette
• Active listening and rapport-building
• Compassion and empathy
• Professionalism and cultural sensitivity
• Organization and time management
• Problem-solving and critical thinking
• Accurate documentation
• Ability to work independently and collaboratively
• Adaptability in a fast-paced environment
• Basic computer proficiency and ability to learn multiple software systems

Physical Requirements & Work Environment

• Primarily office and telephone-based work with occasional travel to community events, meetings, and outreach activities.
• Frequent sitting, typing, and telephone communication throughout the workday.
• 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.

Benefits

Benefits:

• 401(k) matching
• Monthly Stipend
• Dental insurance
• Health insurance
• Life insurance
• Vision insurance
• Paid time off + sick days