PacificSource Health Plans

Member Support Specialist (5-month temporary position)

US-OR-Bend
Job ID
2017-447
Type
Temporary Full-Time
Hiring Pay Range
$16.00-$20.00/hr
# of Openings
1
Status
Non-Exempt

Overview

Position Overview: Work as an integral part of the care management team to serve as an interdepartmental resource to members and community providers/partners. 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. Assist with program development, team processes, as well as build effective member, provider and community partner relationships.

 

** This is a Temporary Full-Time position. Approximate length of assignment: 5 months **

Responsibilities

Essential Responsibilities:

  1. In coordination with the member’s care manager, develop and implement goals and/or plans tailored to assist members in navigating the complexities of the healthcare system and engaging with primary care providers, behavioral health providers, dental providers and other services.
  2. Educate members on understanding and working within the parameters of their benefit structure.
  3. Utilize motivational interviewing and patient-engagement techniques to support members in achieving optimal health outcomes by effectively utilizing their benefits and social/community resources.
  4. Identify and communicate member needs with community resource agencies, work to improve community resource networks and positively impact social determinants of health.
  5. Serve as an interdepartmental liaison between members, providers/agencies, and other community partners.
  6. Identify and screen members for coordination and case management services through a variety of methods, including claims data, referrals, HIE, EMR, and reports.
  7. Screen requests to identify appropriate referrals to case management from multiple internal and external sources.
  8. Work collaboratively with the care management team and other internal departments and lines of business to facilitate the care management process. Assist in organization and facilitation of care management/care coordination meetings.
  9. 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.
  10. Ensure accurate and timely electronic and documentation within multiple computer systems.
  11. Implement Quality initiatives, Oregon Health Authority-mandated programs, and coordinate with providers/community partners in obtaining member Health Related Services.

Supporting Responsibilities:

  1. Manage electronic mailing lists, group phone queue and outgoing mailings.
  2. Assist in developing and monitoring departmental performance metrics, procedures, reports and projects.
  3. Enter and collate electronic data: prepare reports as assigned.
  4. Participate in orientation of new staff.
  5. Participate in team, department, company, and community-related projects/committees as requested.
  6. Make presentations to small and large groups.
  7. Actively participate in quality improvement initiatives.
  8. Meet department and company performance and attendance expectations.
  9. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  10. Perform other duties as assigned.

Qualifications

Work Experience: Requires a minimum of two years’ experience in community service or healthcare agency/state services providing coordination of services. Prefer experience in health care coordination services, use of electronic health record documentation, and community networking and/or facilitating groups.

 

Education, Certificates, Licenses: High school diploma; associates degree in related field or acceptable alternative.  

 

Knowledge: Medical terminology. Proficient in Microsoft Office, including Word, Excel, PowerPoint, On Base, Medical management software (e.g CaseTrakker Dynamo). Excellent verbal and written communication skills and ability to work independently as well as to work effectively on a team. Good working knowledge of how to access community resources and healthcare system.

 

Competencies

Our Values

  • Adaptability
  • Building Customer Loyalty
  • Building Strategic Work Relationships
  • Building Trust
  • Continuous Improvement
  • Contributing to Team Success
  • Planning and Organizing
  • Work Standards
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for our customers’ experience.
  • 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 communities-internal and external.
  • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

 

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time. May be required to use personal vehicle for work-related purposes and to meet with members in the community setting. May need to work outside normal work hours.

 

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. Driving. 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.

 

PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

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