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Member Support Specialist lll

3 months ago

Boise, United States PacificSource Administrators, Inc. Full time

**Position Overview:** W ork as an integral part of the case management team to serve members and community providers/partners by supporting the improvement of patient outcomes through implementation of evidence-based patient navigation services. Provide direct support to 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. The Member Support Specialist III provides individualized assistance to patients to facilitate access to quality care. This position ensures that members are informed of potential care options and have full access to screening, diagnostic, and treatment options. The Member Support Specialist III will serve as a key resource for developing and expanding member access to care resources throughout the PacificSource regions. *Join PacificSource and help our members access quality, affordable care*

**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.**

**Diversity and Inclusion:** PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each persons talents and strengths.

**Essential Responsibilities:**

* Promote Member-centered care and advocate for members within the health system.

* In coordination with the members case manager, develop and implement goals and/or plans tailored to educate and assist members in navigating the complexities of the healthcare system and engaging with primary care providers, behavioral health providers, dental providers and other services.

* Educate members on understanding the parameters of their benefit structure, enrolling in insurance, specialty care and social service programs.

* Educate care community partner and provider teams to better understand and align services, including the promotion of member-focused/service alignment meetings and Case Management services.

* Assist members with referrals, scheduling appointments and ensuring transportation to medical appointments is available.

* Assist members with non-clinical needs for transitions and different phases of care.

* Conduct outreach and engage members by utilizing motivational interviewing and patient-engagement techniques to support members in achieving optimal health outcomes by effectively utilizing their benefits and remaining engaged in their personal care.

* Identify and communicate member needs with community resource agencies, work to improve community resource networks and positively impact social determinants of health.

* Serve as liaison between members, providers/agencies, and other community partners.

* Identify and screen members for coordination, case management services and social determinants of health resource needs through a variety of methods, including claims data, referrals, Health Information Exchange (HIE), PreManage, Electronic Medical Records (EMR), reports and telephonic outreach. Providing the members with the information to obtain the identified services.

* Screen case management referral requests from multiple internal and external sources and connect members to the appropriate level of care.

* Assist the department Team Lead with development of staff on making work flow more effective and training team members.

* Work closely with community partners and providers to develop and facilitate events, meetings and partnerships that positively impact health-related community resources, services, and social determinants of health.

* Advanced familiarity with the Health Related Services program.

* Serve as a resource for the Health Related Services program for others in the organization and community partners as needed.

* Assist in Health Related Services procedures and work processes.

**Supporting Responsibilities:**

* Assist internal departments to meet quality measures as outlined by government regulations.

* Assist in developing and monitoring departmental performance metrics, procedures, reports and projects.

* Participate in team, department, company, and community-related projects/committees as requested.

* Meets department and company performance and attendance expectations.

* Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.

* Perform other duties as assigned.

**Work Experience:** A minimum of four years of experience in community services or healthcare agencies focused on coordination services required. Experience in health insurance and delivering group presentations preferred.

**Education, Certificates, Licenses:** High school diploma or acceptable alternative. Will have Personal Health Navigator certification or ability to complete program within 1 year of hire.

**Knowledge:** Medical terminology. Proficient in Microsoft Office, including Word, Excel, PowerPoint, 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**

* Building Customer Loyalty

* Building Strategic Work Relationships

* Contributing to Team Success

* Planning and Organizing

* Continuous Improvement

* Adaptability

* Building Trust

* Work Standards

**Environment:** Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 25% 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.

**Our Values**

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

* We are committed to doing the right thing.

* We are one team working toward a common goal.

* We are each responsible for customer service.

* 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 many communities-internally and externally.

* We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.

* We encourage creativity, innovation, and the pursuit of excellence.

**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. 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.

locationBoise, IDlocationBoise, IDPacificSource is anything but a typical health insurance company. Founded in 1933, were an independent, not-for-profit organization that puts our members, and their communities firstacross Idaho, Oregon, Montana, and Washington.

It's our 1,600+ employees who make it happen: promoting health equity and partne