PNWCIN, LLC d/b/a Embright is a clinically integrated network that includes providers from leading healthcare organizations in Washington with a plan to expand throughout the Pacific Northwest (including but not limited to Washington, Idaho, Oregon, Western Montana, and Alaska).
The Member Engagement Manager is the functional leader for the programs and services Embright provides to members. There are both clinical and administrative elements of these services with the primary focus on engaging members in their health. The Member Engagement Manager will closely collaborate with the Embright team, particularly the Director, Population Health and the Business Development Account Managers. Embright outsources certain member engagement operations to a third-party vendor. The Member Engagement Manager has the responsibility for interfacing with and managing this vendor.
Embright is committed to providing an outstanding experience to members that is streamlined and leverages data in member outreach. This requires both personal and technical linkages to the providers and plan administrators; the Member Engagement Manager uses these linkages in delivering the desired experience for Embright members.
This document describes the major duties, responsibilities, and authorities of this job and is not intended to represent a complete list of all tasks and functions. It should be understood that incumbents may be asked to perform job-related duties beyond those explicitly described.
· Functional leader for member engagement and outreach programs to the member population, as well as discrete outreach to specific members.
· Manages the vendor to whom Embright outsources the day-to-day operation of member services and engagement. Monitors service delivery and other operational activity as specified in the vendor agreement with Embright. Periodically, on a scheduled basis, reports to Embright leadership on vendor performance and, as appropriate makes recommendations on service expansion/introduction of new services or modification of approach in terms of outsourcing versus insourcing.
· Assists data analyst with managing member eligibility files to assure that they are received from payer and administrators as scheduled and reviews the data for accuracy and completeness. Confirms upload of this data to required systems.
· Receives, manages, and resolves escalated member issues received from the member services vendor, plan administrator or the Account Managers, in a timely and satisfactory manner with communication back to appropriate stakeholders. As appropriate, recommends and implements service improvements to address root causes of escalated issues.
· Ensures that any escalated issues from the client are brought to the functional leader or subject matter expert on the Embright team for resolution and communicates that resolution back to the client.
· Solicits and synthesizes feedback from the client on Embright product/service enhancements or ideas for new product/services. Similarly, brings to the client recommendations on benefit plan enhancements or other employer-directed activity which will support improvement in medical cost, utilization and quality.
· Acquires the necessary data and reports on service delivery and member satisfaction as specified in Embright’s value-based agreements. Where a negative variance to contracted targets occurs, works with the appropriate Embright team members or stakeholders to close the performance gap.
· Collaborates with Director of Integrated Care Management on optimal selection and outreach efforts for member care management
VALUES BASED BEHAVIORS
· Integrity: Do the right thing
· Innovation: Think outside of the box & dare to be unconventional
· Collaboration: Team up & create mutual understanding & clarity
· Agility: Lean into reality & adapt quickly
· Respect: Seek first to understand & embrace culturally competent inclusivity
· Excellence: Be your best & inspire the best in others
· Personal Competencies
· Interpersonal Competencies
- Strong and effective written and verbal communication
- Fostering teamwork
- Open to feedback
- Thriving under volatile, uncertain, complex, and ambiguous circumstances
· Organizational competencies
- Business acumen
- Operational expertise
KNOWLEDGE, SKILLS, & ABILITIES
· Track record of success in the health insurance or healthcare delivery industries
· Experience with contact centers; customer service operations
· Ability to work effectively with highly skilled colleagues
· Demonstrated problem-solving skills
· Demonstrated strong sense of accountability for owning projects/initiatives while thriving as a team player
· Ability to work independently and take initiative, setting priorities, and exercising good judgement while working under the pressure of deadlines, multiple priorities and frequent interruptions
· Ability to deal effectively with constant change
· Ability to work efficiently and demonstrate company values even under challenging circumstances
· Ability to seek out, build, and nurture strong internal and external professional relationships with coworkers, provider administrative staff, vendors, plan administrators and payer operations staff which requires skill in tactful, diplomatic communication
EDUCATION & EXPERIENCE
· 7+ years customer service and contact center experience are required.
· 3+ years healthcare experience is required.
· Previous experience in an entrepreneurial or start-up organization desirable but not required
· Undergraduate degree is