Member Engagement Specialist

Member Engagement Specialist Compensation: $21.00-$24.00 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 interactionEmbrace innovation by trying new ideas, learning quickly, and continuously improving careOwn our roles by staying accountable for outcomes and documenting accuratelyBuild genuine connections with members, families, teammates, and community partners through empathy and cultural sensitivityLead with trust by being consistent, transparent, and following throughCelebrate wins together by recognizing both individual and team achievementsCollaborate with purpose across departments, health plans, providers, and community organizationsAsk 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 coordinationThis 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 sourcesEducate prospective members on Enhanced Care Management (ECM), and other available PHG servicesBuild rapport and establish trust with members through compassionate, professional communicationComplete member enrollments and obtain required consents and documentationConduct follow-up outreach to members who are difficult to reach or have not yet enrolledCoordinate 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 servicesTrack 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 appropriateEducate members on available healthcare, behavioral health, and community resourcesIdentify barriers preventing enrollment or engagement and work collaboratively to resolve themAnswer member questions regarding program eligibility, services, and next stepsEscalate 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 managementCoordinate with health plans, providers, hospitals, correctional facilities, community organizations, and referral partners to support member engagementEnsure all required documentation is complete prior to transferring members into active care managementMaintain communication with referral sources regarding enrollment status when appropriate Documentation & Compliance Maintain accurate, timely, and HIPAA-compliant documentation of all member interactionsComplete enrollment documentation in accordance with PHG policies, CalAIM requirements, and health plan standardsEnsure documentation is complete, accurate, and audit-readyMaintain 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 assignedPromote awareness of ECM, Community Supports, and PHG services within the communityBuild and maintain positive relationships with community organizations and referral partnersAssist with outreach initiatives designed to increase awareness of available services and generate member referrals Requirements Qualifications Required High school diploma or equivalent requiredAssociate's or Bachelor's degree in social work, public health, human services, healthcare administration, or a related field preferredMinimum of 1-2 years of experience in customer service, healthcare, member services, outreach, care coordination, insurance enrollment, call center operations, or a related fieldExcellent verbal communication and interpersonal skillsComfortable spending the majority of the workday conducting outbound member callsStrong organizational skills with the ability to manage multiple prioritiesBasic computer proficiency and ability to quickly learn new software platformsValid California driver's license and reliable transportation for occasional community events or meetings Preferred Experience working with Medi-Cal populationsKnowledge of Enhanced Care Management (ECM), Community Supports (CS), CalAIM, or managed careExperience assisting with Medi-Cal or BenefitsCal applicationsBilingual in English and Spanish, Vietnamese, Mandarin, Russian, or another language commonly spoken within the communities served Skills & Competencies Exceptional customer service and member engagementStrong verbal communication and phone etiquetteActive listening and rapport-buildingCompassion and empathyProfessionalism and cultural sensitivityOrganization and time managementProblem-solving and critical thinkingAccurate documentationAbility to work independently and collaborativelyAdaptability in a fast-paced environmentBasic 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 activitiesFrequent sitting, typing, and telephone communication throughout the workdayAbility to occasionally travel throughout assigned service areas for outreach events and meetingsAbility to lift up to 25 pounds of outreach materials or supplies as needed Benefits Benefits: 401(k) matchingMonthly StipendDental insuranceHealth insuranceLife insuranceVision insurancePaid time off + sick days