Member Engagement Specialist

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.

Responsibilities

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; Complete member enrollments and obtain required consents and documentation; Coordinate justice-involved member referrals and warm handoffs to support successful transitions into ECM services; Assist members with Medi-Cal applications, renewals, BenefitsCal applications, and other public benefit navigation; Collaborate with Lead Care Managers to ensure smooth transitions from enrollment into ongoing care management; Maintain accurate, timely, and HIPAA-compliant documentation of all member interactions; Represent Pacific Health Group at health fairs, community events, provider meetings, and outreach opportunities as assigned

Requirements

High school diploma or equivalent; 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

Nice to have

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

Benefits

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