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.

The Member Engagement Specialist works with the population health team in supporting 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 Specialist will closely collaborate with the Embright team, particularly the Director of Population Health and the Business Development Account Managers.  Embright outsources certain member engagement operations to a third-party vendor. The Member Engagement Specialist has the responsibility for interfacing with and managing this vendor.  

Embright is committed to providing outstanding experience to members that is streamlined and leverages data in member outreach and assistance. This requires both personal and technical linkages to the providers and plan administrators; the Member Engagement Specialist 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.   Employees may be asked to perform job-related duties beyond those explicitly described.

PRINCIPAL ACCOUNTABILITIES 

  • Responsible for ensuring that appropriate member outreach and assistance is occurring smoothly and effectively to maximize member engagement in achieving optimal clinical outcomes
  • 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 
  • Receives, manages, and resolves escalated member issues 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 

    • Manages waiver requests for out of network services in coordination with the Chief Medical Officer and network medical directors 
    • 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 outreach efforts for member care management 
    • Operationalizes member outreach in support of Embright focused population health efforts in partnership with the Embright Population Health Team  


    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 


    LEADERSHIP COMPETENCIES   

      • Personal Competencies  
      • Integrity 
      • Accountability 
      • Methodical 
      • Investigative 
      • Interpersonal Competencies 
        • Strong and effective written and verbal communication 
        • Collaboration 
        • Fostering teamwork 
        • Open to feedback 
        • Thriving under volatile, uncertain, complex, and ambiguous circumstances 
      • Organizational competencies 
      • Data-driven 
      • Business acumen 
      • Operational expertise 


    MINIMUM QUALIFICATIONS 

    KNOWLEDGE, SKILLS, & ABILITIES 

      • Record of success in the health insurance or healthcare delivery industries 
      • Excellent communication and customer services skills 
      • Experience with customer service operations 
      • Demonstrated problem-solving skills 
      • Demonstrated strong sense of accountability for owning projects and 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  

      • Healthcare experience is required 
      • Undergraduate degree is preferred 
      • Previous customer service experience preferred 
      • Previous experience in an entrepreneurial or start-up organization desirable 
      • Previous experience with vendor and client management desired 
      • Previous experience working in or with a contact/call center preferred 
      • Project/program management a plus


      The Embright team believes that each employee makes a significant contribution to our success. Contributions can be within and outside of assigned responsibilities. It is our expectation that each employee will offer his/her services wherever and whenever necessary to ensure the success of our endeavors.


      Job descriptions represent a general outline of job duties, functions, and qualifications. They are not intended to be comprehensive in nature. In addition, jobs evolve over time and therefore their description may not reflect the precise nature of the position at a given point in time.


      It is Embright’s policy to base hiring decisions solely on the individual's ability to perform essential job functions. Persons with disabilities are eligible for this position provided they can perform those functions with reasonable accommodation.

      This position has been filled. Would you like to see our other open positions?