Pacific Health Group

Compensation

Full Description

Job description Member CoordinationWe are excited to invite a dedicated and versatile Member Coordinator to join our dynamic team. As a key player in our member coordination department, this role is critical to ensuring the success and efficiency of our organization. You will be responsible for managing a wide range of member-focused activities that contribute directly to the quality of services we provide. This is an excellent opportunity for a highly organized individual with a passion for customer service, healthcare, and operational excellence. Responsibilities:Member Assessments: Conducting comprehensive evaluations of our members' needs, preferences, and eligibility. This involves in-depth conversations with members, reviewing their medical history, and collecting relevant data to determine the best course of action for their care.Referral Processes: Managing and optimizing our systems for directing members to appropriate services, healthcare providers, or specialists. This includes maintaining relationships with service providers and ensuring smooth information transfer.Lead Care Management: Taking the lead in coordinating care for high-priority or complex cases. This involves closely collaborating with healthcare providers, family members, and other involved parties to ensure that the member receives continuous care. You will monitor the progress of these cases, address any emerging challenges, and provide timely updates to stakeholders to ensure that each member’s health and wellbeing are effectively managed.Quality Assurance: Implementing and maintaining quality control measures across all department activities. This includes regular audits, performance reviews, and continuous improvement initiatives to ensure high standards of service. Additionally, quality assurance includes obtaining member feedback about their experience with our company thus far.Data Entry: Accurately inputting and updating member data in the organization's databases and management systems. This includes entering personal details, case information, service usage, and other relevant data, ensuring that all records are complete, accurate, and up-to-date. You will also be responsible for maintaining confidentiality and ensuring data integrity while handling sensitive information.Call Center Supervision: Overseeing the operations of the call center, including inbound calls, monitoring call quality, overseeing incoming and outgoing faxes, and implementing strategies to improve customer service and efficiency.Patient Verification: You will play a vital role in verifying the identity and eligibility of patients or members, ensuring that all provided information is accurate and up-to-date. This process may involve cross-referencing multiple databases, contacting other organizations, and liaising with team members to ensure that all necessary documentation is complete and correct.Resource Development: Creating, updating, and maintaining resources that support the team’s daily activities. This could include developing training materials, creating process documentation, or compiling informational resources for members. Your contributions will ensure that the team has access to up-to-date tools that streamline workflows and enhance overall efficiency.Mailing Distribution: Overseeing the distribution of physical materials such as flyers, brochures, and other printed information to members.Additional Responsibilities: In addition to the tasks outlined above, you will be expected to take on any additional duties as needed, which may include administrative support, system updates, or any other tasks that contribute to the overall success of the department and organization.Qualifications:Strong organizational skills with a keen eye for detailProven reliability and self-motivation to manage multiple tasks efficientlyAdaptability to occasional changes in the workplace environmentProactive attitude and strong work ethic with a desire to contribute to team successComfort with speaking on the phone for extended periods and handling sensitive informationAt least 2+ years in an office/administrative environment, ideally in a healthcare or member services settingKey Attributes:Excellent communication skills, both written and verbalAbility to multitask and prioritize effectively in a fast-paced environmentDetail-oriented with a focus on accuracy and high-quality service deliveryTeam player with a positive attitude and collaborative approachWorking Conditions:Fully remote, 40 hours per weekPay: $21 - $24 per hourHours: 1:30 PM - 10:00 PM, Monday through FridayJob Type: Full-time Benefits:401(k)Dental insuranceHealth insurancePaid time offVision insuranceShift:1:30pm-10pmWork Location: Remote