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Pacific Health Group

Integrated Medi-Cal care coordination provider

Member Engagement Specialist

Case Management & AdvocacyConfirmed live in the last 24 hours
Full-timeRemote in USA

About the Job

Requirements

  • A high school diploma or equivalent is required.
  • A valid driver's license and reliable transportation are required for occasional community events or meetings.
  • The role requires 1–2 years of experience in customer service, healthcare, member services, outreach, care coordination, insurance enrollment, call center operations, or a related field.
  • The role requires excellent verbal communication and interpersonal skills.
  • The candidate must be comfortable spending the majority of the workday conducting outbound member calls.
  • The candidate must have strong organizational skills and be able to manage multiple priorities.
  • The candidate must have basic computer proficiency and be able to quickly learn new software platforms.

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 and other available Pacific Health Group 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 Enhanced Care Management services.
  • Track referral status from receipt through enrollment and ensure timely follow-up with prospective members.
  • 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.
  • Collaborate 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 required documentation is complete before transferring members into active care management.
  • Maintain communication with referral sources regarding enrollment status when appropriate.
  • Maintain accurate, timely, and HIPAA-compliant documentation of member interactions.
  • Complete enrollment documentation in accordance with Pacific Health Group policies, CalAIM requirements, and health plan standards.
  • Ensure documentation is complete, accurate, and audit-ready.
  • Maintain confidentiality while adhering to federal, state, and organizational compliance requirements.
  • Represent Pacific Health Group at health fairs, community events, provider meetings, and outreach opportunities as assigned.
  • Promote awareness of Enhanced Care Management, Community Supports, and Pacific Health Group 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.
  • Travel occasionally throughout assigned service areas for outreach events and meetings, and lift up to 25 pounds of outreach materials or supplies as needed.

Desired Qualifications

  • An associate's or bachelor's degree in social work, public health, human services, healthcare administration, or a related field is preferred.
  • Experience working with Medi-Cal populations is preferred.
  • Knowledge of Enhanced Care Management, Community Supports, CalAIM, or managed care is preferred.
  • Experience assisting with Medi-Cal or BenefitsCal applications is preferred.
  • Bilingual ability in English and Spanish, Vietnamese, Mandarin, or another language commonly spoken within the communities served is preferred.

About the Company

Pacific Health Group

Integrated Medi-Cal care coordination provider

Pacific Health Group provides integrated Medi-Cal care coordination in California, working with 39 health plans to serve more than 38,000 members across 44 counties. Its flagship Enhanced Care Management coordinates medical, behavioral, and social services for members with complex needs, complemented by Community Supports like housing navigation, rent assistance, medically tailored meals, and home modifications. Street Medicine reaches unsheltered individuals, while Community Health Workers provide culturally responsive care navigation and advocacy; additional services include behavioral health support, medical transportation, and a Clubhouse program for adults with mental illness. The approach follows CalAIM’s whole-person care, addressing social determinants of health to reduce fragmentation and improve stability for at-risk Medi-Cal beneficiaries.

Company size
51-200
Company stage
Not listed
Total funding
Not listed
Headquarters
Carlsbad, CA
Founded
2023

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