Outreach Engagement and Retention Specialist

Position Summary:

The Outreach Engagement and Retention Specialist is responsible for identifying, engaging, and enrolling eligible members into the Enhanced Care Management (ECM) program. This role serves as primary outreach and engagement specialist and is a key liaison between members, care teams, and health plans, ensuring members receive coordinated, comprehensive care services that address medical, behavioral, and social needs. The ECM Enroller operates with a high degree of independence and initiative, driving outreach effectiveness and program compliance through ownership of workflows, systems, and member relationships at the primary access point of care.

Schedule:

- Onsite presence – Monday through Friday 8:00 a.m. – 5:00 p.m.

- Flexible, including evenings and weekends based on operational needs.

- Hours worked per week may exceed 40 hours

Duties and Responsibilities

- Ensure the highest capture rate of engagement and retention of ECM membership from NECCs internal active patients who qualify for the ECM program.

- Ensure the highest rate of Capture and Engagement of External members identified through external referral lists, including health plans, community partners, homeless shelters, and other referral sources.

- Ensure the highest rate of Re-Engagement / Membership Disposition Status of ECM members when they are lost to communication.

- Ensure a high level of engagement and participation of eligible members into the ECM program.

- Ensure all potentially eligible ECM members identified through internal and external sources are engaged into care, with urgency and consistency.

- Explain ECM program services, benefits, eligibility requirements, and member rights in a clear and understandable manner.

- Complete outreach attempts daily across multiple communication channels. (i.e. telephone, SMS, and written correspondence) tailored to the individual members needs and circumstances.

- Ensure accurate and timely documentation of all outreach attempts, methods used, outcomes and coordination activities, in applicable tracking systems per DHCS, contracted health plans, and NECC internal standards, ensuring no member falls through the gap due to missed contact cycles.

- Proactively problem-solve barriers to contacting members and escalate unresolved cases appropriately to care team/management.

- Verify Medi-Cal eligibility for each member using health plan provider portals prior to enrollment activities.

- Submit internal and external referrals to the contracted health plans and monitor submission to close referral loop.

- Build rapport and establish trust with members and their families. Reengaging members who have disengaged from ECM services or declined ECM services through targeted outreach initiatives.

- Ensure full-cycle engagement and enrollment for each potential member is executed thoroughly and timely

- Ensure facilitation of warm hand-off transition of member to assigned LCM for ongoing engagement and program engagement.

- Identify and address eligibility issues to prevent gaps in coverage and care.

- Ensure daily membership outreach activity and outcome is documented, tracked, and submitted to ECM Management.

- Maintain confidentiality of all patient and member information in compliance with HIPAA and NECC policies and procedures.

- Other duties as designated by ECM Management.

Qualifications

Minimum Requirements

- Proficiency in Microsoft Office (Word, Excel, Outlook, PowerPoint)

- Excellent Communication Skills

- Excellent Customer Service (Bedside Manners)

- Bilingual English/Spanish required

- Ability to work as a team player and work independently

- Ability to work with complex and multi-faceted tasks and systems

Required Education/Experience and/or Licensure/Certifications

- High School Diploma or GED required.

- Associate’s degree or higher preferred.

- Minimum one (1) year of experience in a customer service, call center, or patient-facing role.

- Experience in a Federally Qualified Health Center (FQHC) or community health setting preferred

- Experience working in outreach and customer service within the medical office and behavioral health environments with individuals who struggle with chronic illness, substance use disorders and mental health issues is preferred.

- Familiarity with Medi-Cal managed care system and eligibility requirements preferred

- Strong organizational skills and attention to details to perform tasks accurately and efficiently.

- Valid CA Driver’s License and Proof of Insurance

Working Conditions

- OSHA Category 3 Involves no regular exposure to blood, body fluids, or tissues, and tasks that involve exposure to blood, body fluids, or tissues are not a condition of employment.

- The work is majority of the time sedentary in nature.

- The employee is regularly required to communicate, frequently required to use repetitive motions, move, remain stationary, regularly push, pull and lift up to 20 pounds and occasionally push, pull and lift up to 40 pounds.

- Must possess mobility to work in a standard office/clinic setting (in some cases both settings) and to use standard

office/clinic equipment, including a computer, stamina to maintain attention to detail despite interruptions, read printed

materials and use a computer, and communicate in person and over the telephone.