Kaiser Permanente Member Engagement Specialist - Grade 304 (Bilingual Spanish) in Sacramento, California
Provide Kaiser Permanente new members that are currently receiving a subsidy (for example those who are dual eligible (Medicare-Medicaid), Medicaid or Covered California) an onboarding service, including outreach, orientation, and education on Kaiser Permanente (KP) clinical and non-clinical services and resources. Provide member information to health care coordination teams to facilitate care activities within Kaiser Permanente and through community based agencies.
Conduct proactive outreach to new members receiving a subsidy, especially to those in targeted groups (e.g. those with high failure to keep appointments or those eligible for the Nurse Family Partnership program) to improve health outcomes and bolster patient engagement in their own health and health care.
Provide field based outreach and engagement, including home visits and co-located services in community based settings.
May conduct home assessments, including checking for any potential situations that may adversely affect the member.
Articulate and advocate for community needs within KP and with community agencies. Provide resources and broker linkages to community-based agencies/resources (e.g. transportation, shelter, food bank, etc.). For example, facilitate transportation services for members in need of transportation assistance to their scheduled medical appointments.
Conduct a pre-assessment of the member by reviewing KP systems, e.g. KP Health Connect, FOUNDATIONS, etc., prior to engaging members to assess potential services that may be helpful for member and members household, as well as understand any prior connection/coverage with KP.
Assess the need for and coordinate referrals to Kaiser Permanente services (e.g. Care Coordination, Health Education, etc.) when member expresses concerns that are serious or there are social determinant needs.
Orient and educate members on Kaiser Permanente benefits and services, including assisting with selection and/or change of primary care physician, explaining dental coverage and helping members determine their dental carrier, educating on Advanced Directive information, and explaining the difference between emergency and urgent care visits.
Register members for kp.org, reset kp.org password for members and household members and assist with downloading Kaiser Permanente Prevention app.
Assist with access to routine and preventive services at Kaiser and in community, including prompting for Cancer Screening when applicable and scheduling screening and fecal immunochemical test (FIT) test mail out.
Schedule eConsults for pharmacy, covering, for example, transfer of medications and immediate questions/concerns about medications, Telephone Appointment Visit (TAV)or Contraception Counseling.
Ensure that new members meet all regulatory compliance requirements (e.g. Department of Healthcare Services (DHCS), Centers for Medicare & Medicaid Services (CMS), and/or Department of Managed Health Care (DMHC)).
Schedule appointments as needed.
Work with the member to complete contractually required health assessments, Initial Health Assessment (IHA) and Initial Health Education Behavioral Assessment (IHEBA), if one has not been completed, including completion over the phone or at the member's house.
Participate in pilots requiring member engagement; for example, asthma, outbound calls for appointment reminders, etc.
Participate as a key contributor in process improvement efforts.
Conduct monthly quality audits, e.g. quality assurance (QA) for lack of documentation in Health Connect, outreach not conducted timely, etc. using Word and Excel.
Assist in the development of training documents and workflows using Word and Excel.
Generate weekly status reports using Word and Excel.
Respond to inbound calls and assists as needed.
Other duties as assigned.
- One (1) year work experience in community social services, social services (inpatient or outpatient), education or a related field.
Bachelor's degree or four (4) years work experience in community social services, social services (inpatient or outpatient), education or a related field.
High School degree or GED.
License, Certification, Registration
- Valid Drivers License.
Must possess high level of skills in customer service and must maintain strict patient confidentiality.
Will travel within the service area.
Excellent verbal, telephone techniques and written communication skills required; strong interpersonal and organizational skills.
Effective working both independently and as a team member.
Ability to exercise independent judgment.
Ability to deal with ambiguous situations.
Ability to work collaboratively and flexibly with physicians, providers and all levels of staff.
Must pass basic PC skills test and basic Word and Excel tests.
QBS Level II Spanish required.
Must be willing to work in a Labor Management Partnership.
Two (2) years work experience in customer service in a healthcare environment.
Bilingual in other languages preferred, such as Spanish or Chinese.
Experience with underserved populations, government subsidized programs and community based organizations/resources preferred.
PC Skills & Basic Word and Excel
*If it is determined that you need to complete testing to qualify for this position, you will receive an email inviting you to take the assessment(s) listed above. Passing test scores remain on file for one year.
TITLE: Member Engagement Specialist - Grade 304 (Bilingual Spanish)
LOCATION: Sacramento, California
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.