ECM Enrollment Specialist

Location:

CA Remote – California Residents ONLY

Employment Type:

Full-Time

Schedule:

Monday–Friday, 8:30 AM–5:00 PM
Work Environment:
Remote

Reports To:

Member Engagement/Enrollment Leadership
Compensation: $22.00 – $24.00 per hour, depending on experience and qualifications.

At Pacific Health Group, we care deeply about the people and communities we serve. We meet individuals with kindness, respect, and understanding—listening first, honoring each person's journey, and offering support without judgment. Through compassionate, person-centered healthcare, behavioral health services, and social supports, we help individuals navigate barriers to care and connect with the services they need to achieve greater health, stability, and independence.

The Enrollment Specialist is responsible for helping prospective Pacific Health Group members navigate the administrative steps required to obtain and maintain healthcare coverage and become eligible for PHG services.

Many individuals identified through Pacific Health Group's outreach efforts are uninsured, have inactive Medi-Cal coverage, have pending applications, need assistance completing a renewal, or are not yet enrolled with the appropriate Medi-Cal Managed Care Plan (MCP). The Enrollment Specialist takes ownership of these cases and works to move members through the coverage and enrollment process as efficiently as possible.

This position assists individuals with Medi-Cal applications and renewals, monitors pending applications, follows up on eligibility issues, assists with denied or discontinued coverage, supports appeals and submission of requested documentation, helps members navigate Managed Care Plan enrollment, and tracks each case until the individual is ready to transition into PHG's applicable programs.

The Enrollment Specialist serves as the administrative bridge between initial member engagement and active program enrollment, allowing care management staff to focus on members who are ready to receive services.

For many individuals served by Pacific Health Group, lack of active insurance coverage is one of the first barriers preventing access to care.

The Enrollment Specialist helps remove that barrier by ensuring individuals do not become lost during lengthy or complicated Medi-Cal processes. Through persistent follow-up, accurate documentation, and hands-on navigation assistance, this position helps move prospective members from uninsured or pending status to active coverage and program readiness.

• Assist uninsured prospective members with completing and submitting Medi-Cal applications through Benefits Cal or other applicable enrollment channels.
• Guide members through the application process and explain required documentation, verification requirements, and next steps.
• Assist members with Medi-Cal renewals and redeterminations when coverage is approaching expiration or has been discontinued.
• Help members gather and submit requested eligibility documentation.
• Review applications for completeness and accuracy before submission whenever appropriate.
• Educate members on the Medi-Cal enrollment process and expected next steps in clear, easy-to-understand language.

• Maintain ownership of pending Medi-Cal cases from initial application through final eligibility determination.
• Regularly check application and eligibility status through Benefits Cal and other approved systems.
• Follow up with members, counties, health plans, and other appropriate entities regarding outstanding applications or eligibility issues.
• Identify missing documentation or other barriers delaying eligibility…