POSITION SUMMARY: The Client Services Specialist plays a key role in supporting Medi-Cal members with complex needs through Enhanced Care Management (ECM), Community Supports, and other CHS programs/services. This position focuses on provider coordination, external referral management, and proactive outreach to eligible populations. The Outreach Specialist ensures that members are connected to the appropriate services by maintaining an up-to-date provider list from Managed Care Plans (MCPs) and fielding all incoming external referrals.
DUTIES:
Member Outreach & Engagement
- Conduct outbound outreach calls to Medi-Cal members identified as eligible for Enhanced Care Management (ECM) or Community Supports.
- Engage members through various modes including in-person, phone calls, and other methods to explain ECM and Community Supports services, assess interest, and facilitate enrollment.
- Assist members in completing referrals, gathering documentation, and ensuring all intake steps are completed.
- Connect enrolled members to the appropriate Care Coordinator for ongoing care planning and support.
- Prioritize outreach to high-need populations, including individuals experiencing homelessness, living with serious mental illness, substance use disorders, or complex chronic health conditions.
- Conduct proactive outreach in diverse community settings including parks, parking lots, community events, and correctional facilities to engage individuals in need, build trust, and connect them with appropriate services and resources.
Referral Management
- Receive, review, and triage external referrals for ECM and Community Supports services.
- Assist with referral intake, including verifying eligibility and ensuring timely responses to referring providers or agencies.
- Track referral progress and outcomes, following up as needed to ensure members are engaged and connected to services.
Provider Coordination
- Maintain up-to-date ECM and Community Supports provider lists received from Managed Care Plans (MCPs).
- Ensure internal systems reflect accurate provider information.
- Serve as a liaison between providers, MCPs, and internal teams to streamline referral and enrollment processes.
Community & Partner Engagement
- Build and maintain relationships with community-based organizations, healthcare providers, shelters, clinics, and social service agencies to support referral pipelines.
- Represent the organization at community events, resource fairs, and collaborative meetings to raise awareness about ECM and Community Supports programs.
Documentation & Reporting
- Document all outreach activities, member interactions, referral outcomes, and provider updates in internal systems accurately and in a timely manner.
- Identify and report trends, barriers to engagement, and gaps in provider availability to inform program improvements.
Other Duties
- Perform other duties as assigned in support of program operations and organizational goals.
