Member Engagement Specialist

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. This 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.

Member Outreach & Enrollment

• 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.

Member Support

• Assist members with Medi-Cal applications, renewals, BenefitsCal applications, and other public benefit navigation when appropriate.
• Educate members on available healthcare, behavioral health, and community resources.
• 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.

Documentation & Compliance

• Maintain accurate, timely, and HIPAA-compliant documentation of all member interactions.
• Complete enrollment documentation in accordance with PHG policies, CalAIM requirements, and health plan standards.
• Ensure documentation is complete, accurate, and audit-ready.
• Maintain 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 assigned.
• Promote awareness of ECM, Community Supports, and PHG services within the community.
• Build and maintain positive relationships with community organizations and referral partners.
• Assist with outreach initiatives designed to increase awareness of available services and generate member referrals.