Member Support Specialist Team Lead

Boise, Idaho

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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 person's talents and strengths.

Position Overview: Supervise and provide guidance to Case Management Member Support Services team members including Member Support Services, Representatives, and other support staff regarding company policies, procedures, and workflow. Responsible for hiring, training, coaching, counseling, and evaluating team member performance. Demonstrate effective leadership by coaching to improve individual performance, develop teamwork and team support, manage change and encourage innovation, build collaborative relationships, encourage involvement and initiative, and develop increased vision and commitment to goals in others. Assist in resolution of provider/community partner and member issues referred to Case Management Department services.

Essential Responsibilities:
1. Provide supervision, coaching, training, performance evaluation and leadership to assigned staff. Assist with hiring, corrective actions, and termination of employees. Assure Medicaid Case Management Member Support Services processes, production and quality meet department and company standards.
2. Evaluate performance of team members. Analyze results of performance reports for each team member to determine training needs related to personal performance and department goals.
3. In coordination with the member's case manager, assist team to develop and implement goals and/or plans tailored to assist members in navigating the complexities of health care and social systems.
4. Create, evaluate, and track departmental metrics to measure departmental and staff performance.
5. Oversee and assist team in identifying and creating exceptional external and internal customer communication networks and educational opportunities regarding community resources and social determinants of health.
6. Utilize motivational interviewing and engagement techniques to support internal and external customers in utilizing health care/community resources and interagency supports.
7. Serve as liaison between members, providers/agencies, and other community partners.
8. Identify members for coordination and case management services through a variety of methods, including claims data and reports.
9. Screen requests to identify appropriate referrals to case management from multiple internal and external sources.
10. Work collaboratively with the case management team to help facilitate case management processes, Integrated Care Management meetings and assist in other case management/care coordination meetings.
11. Participate in the development and maintenance of the Case Management Department Manual, policies/procedures and processes.
12. Perform provider/community partner and staff education and introductory meetings and presentations, including PacificSource mission and business, Intensive Care Coordination Services and Special Health Care Needs, Case Management processes, community resources and social determinants of health, member plan information, as well as contacting appropriate PacificSource representatives for assistance. Prepare materials and presentations for the meetings.
13. Investigate and settle issues not resolvable by Member Support Specialist and Case Management staff. Relay information for dispute resolution to appropriate departments and personnel.
14. 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. Ensure accurate and timely documentation.

Supporting Responsibilities:
1. Meet department and company performance and attendance expectations.
2. Manage electronic mailing lists and outgoing mailings.
3. Assist with the development of departmental procedures, reports and projects.
4. Enter and collate electronic data: prepare reports as assigned.
5. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
6. 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. Supervisory experience preferred.

Education, Certificates, Licenses: High school diploma or equivalent.

Knowledge: Excellent verbal and written communication skills and ability to work independently as well as to work effectively on a team. Microsoft Office, including Word, Excel, PowerPoint, medical management software. Good working knowledge of how to access community resources and healthcare system. Basic math skills required, including percentages, ratios, graphing and spreadsheet skills. Strong work ethic and ability to work effectively with a variety of personalities at varying skill levels.

• 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.

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.

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