Member Engagement Specialist (Bilingual Spanish)

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 members 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.

Grade: 304