Apply on line at http://www.alohacare.org/Careers/Default.aspx
The Company:
AlohaCare is a local, non-profit health plan serving Hawai`i’s low-income residents with free Medicaid and dual Medicare health insurance coverage. Our members include children, seniors, and adults residing on all islands. We provide comprehensive benefits and managed care services with an emphasis on healthy living habits and preventive primary health care. Our approach is to meet the whole-person health and social needs of members. Through our community partnerships we offer innovative services such as connection to social service agencies, Native Hawaiian healing services and in-home primary care for qualified members. Our mission is to serve in the true spirit of aloha by ensuring and advocating for access to quality health care for all. We are Hawaii’s third-largest health plan and offer a wide network of quality primary care, specialists, hospitals, pharmacies and among many other providers across the state.
The Culture:
AlohaCare employees have a passion for helping Hawai`i’s most underserved communities. Our caring culture is fundamental to our company-wide team approach to providing high quality services. We support our employees with a supportive and positive work environment, healthy work-life balance, continuous communication, and a generous benefits package.
AlohaCare’s leadership empowers and engages its employees by recognizing outstanding job performance and collaboration. We share organization-wide updates during quarterly All Staff meetings. We encourage participation in volunteer and educational opportunities. We put a high value on honesty, respect, and trust-building. We encourage open-door, two-way, and frequent communication.
AlohaCare’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time-off, 401k employer contribution, referral bonus and pretax transportation and parking program.
The Opportunity:
The Behavioral Health (BH) Assistant Care Coordinator supports the functions of the BH/CIS and TOC Program Managers and BH Director by assisting with the Care Coordination activities associated with the BH CCS and SEBD program carve out monitoring, CIS claims review and monitoring, and specific BH resource management, i.e. ABA service provisions and providers.
In addition, the Behavioral Health (BH) Assistant Care Coordinator assists in the compilation of data for QI, HEDIS, and MQD reporting, as needed. Job functions are performed in accordance with requirements of the State’s DHS-Med-QUEST Division, CMS Medicare requirements, AlohaCare’s policies and procedures, and NCQA standards.
Primary Duties and Responsibilities:
- Assist with referrals and preparation of documents necessary for disability determination or to the specialized programs such as the SEBD program administered by the CAMHD, or to the Community Care Services (CCS) program.
- Assist with the creation of the authorization of shells and process as required.
- Follow up with members who are discharged from the Child and Adolescent Mental Health Division (CAMHD) and who are returned to our base plan for BH services.
- Follow up with the members who no longer meet the criteria for additional and intensive behavioral health services from the CCS program, and who are transitioned back to the base plan for BH services.
- Keep abreast of community resources for alternative health care, support services, social services and recreational services that may be appropriate for the QUEST Integration and Medicare BH members. Compile and maintain resources for ease of use by Clinician/Care Coordinators.
- Assist Clinician/Care Coordinators/Housing Coordinators in the identification of appropriate community resources.
- Coordinates with MM, CS, SC, TOC, Pharmacy, and TCSS, any other internal departments, the authorizations and physician orders for entry into G7 or QNXT, under the direction of a Clinician/Care Coordinator/Housing Coordinator.
- May do some member, PCP, and provider contacts under the supervision of the Clinicians/Supervisor or Manager.
- Prepare and coordinate letters/correspondences to members, PCPs, and providers as requested by the Clinicians/ Supervisor/Manager.
- Assist the Supervisor/Manager in generating and monitoring utilization (UM) reports, BH reports, member service reports, HEDIS, QI reports, and claims resolutions.
- Participate in staff meetings and trainings, take minutes/attendance, and post on BH Share Point.
- Assist in the maintenance of Program related materials received from providers, as well as educational materials.
- Assist the department with claims review and or denial reconciliation when requested.
- All other duties assigned.
- Adhere to regulatory compliance and quality guidelines as well as AlohaCare policies and procedures.
- Responsible for maintaining AlohaCare’s confidential information in accordance with AlohaCare policies, state and federal laws, rules and regulations regarding confidentiality. Employees have access to AlohaCare data based on the data classification assigned to this job title.
Requirements:
- Understanding the concepts of care coordination within the managed care field.
- Achieves results, builds trust, communicate effectively, customer and quality focused.
- Strong interpersonal and facilitation skills with the ability to communicate with all levels of the organization.
- Strong, effective, and precise written and oral communication skills; speak clearly and persuasively in positive or negative situations.
- Professional telephonic etiquette skills.
- Ability to solve problems, analyze, think critically, and make good judgments.
- Strong customer service skills and be able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills.
- Able to work independently with minimal supervision.
- Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment.
Preferred Requirements:
- Associates or bachelor's degree in health service Field or related field or equivalent combination of education and experience.
- Minimum of 2 years of work experience as a case manager in a community setting.
- Knowledge of community resources including specialty care, behavioral health care resources, inpatient and outpatient community resources.
Mental, Physical and Environmental Demands:
Salary Range: $20.00 - $24.00 annually
AlohaCare is committed to providing equal employment opportunities to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veteran status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.