Member Engagement Specialist

About the role

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, community organizations, and other referral sources.

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
• 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
• Aid members with Medi-Cal applications, renewals, BenefitsCal applications, and other public benefit navigation when appropriate
• 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

Requirements

• 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
• 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