Behavioral Health Program Manager

Apply online 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 Program Health Manager provides administrative oversight and clinical guidance for the Behavioral Health Program. Partners with BH Director to ensure compliance with AlohaCare’s policies and procedures, DHS, CMS, NCQA requirements for behavioral healthservices. This role is a resource for other departments in addressing members with behavioral health needs in support of a process of recovery.

Primary Duties and Responsibilities:

• Provides oversight of AlohaCare’s Behavioral Health program to ensure compliance with requirements/standards set by DHS, CMS, and NCQA.
• Being aware and knowledgeable of key requirements (contractual, regulatory, accreditation) related to behavioral health services and the reference materials supporting these.
• Ensuring all P&Ps required are kept up to date, accurate and meeting requirements
• Monitoring and publishing departmental performance measures and comparing results against requirements or other established benchmarks and institute corrections as necessary

• Responsible for completion, validation, and timely submission of all required Behavioral Health reports based on the plan’s contractual obligations to the State/MQD, and CMS.

• Participates in the Quality Improvement process along with the BH Coordinator +to ensure that quality care and services are provided to the member in a timely manner. This includes monitoring processes and documentation as well as identifying and researching potential quality of care issues and forwarding information to the Quality Improvement Department.
• Monitors/ Coordinates activities with the other AlohaCare Departments (e.g. QUEST Integrated activities) to support and achieve department goals and initiatives.
• Has oversight and monitors referrals to specialized programs, such as the Child & Adolescent Mental Health Division (CAMHD) for SEBD services, and Community Care Services (CCS) for adults who may need additional and intensive behavioral health services
• Triages and coordinates resolution of BH escalated issues as requested by MQD and/or Director.
• Participates in appropriate MQD workgroups as identified by BH Director
• Provides consultation, education, and training to plan staff and/or identify outside partners who are willing to provide our staff with such opportunities.
• Provides consultation, education, and training to providers in conjunction with AlohaCare’s Provider Network Development Department.
• Identifies and develops community and other resources available to assist with member needs.
• Participates in community meetings such as but not limited to the “National Alliance for the Mentally Ill” (NAMI), Mental Health America, or community coalitions to increase/improve network of services available to our members, as well as to promote AlohaCare’s presence in the community as identified by BH Director.
• Ensures behavioral health representation at the Inter-disciplinary department team meetings or Inter-disciplinary care team meetings, as well as other ad-hoc meetings.
• Participate in managers’ meetings
• Participates in the Provider Advisory Council meetings
• Participates in organizational workgroups or coordinates BH representation by other BH staff, as appropriate
• Provides Direct oversite, training, guidance and mentoring to the Certified Peer Specialist positions as well as for the BH administrative position
• Participates in UM rounds as needed/indicated.
• Assists/Completes needed 1157 forms, or other BH screening tools, if applicable/needed.
• Monitor, report, and strategize with Health Services on how to reduce readmissions.
• 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:

• Master’s degree in social work, or related field or equivalent combination of education and experience.
• Clinical licensure meeting the requirements for Qualified Mental Health Professional (QMHP), LCSW, LMHC, LMFT, Psychologist, etc. in the State of Hawaii.

• Minimum of 2 years of work experience as a case manager in a community setting.
• Minimum of 3 years of experience managing and developing a team.
• Strong knowledge of community resources including specialty care, behavioral health care resources, inpatient and outpatient community resources.
• Knowledge of the managed health care field (both conceptually and operationally).
• Achieves results, builds trust, communicate effectively, customer and quality focused.
• Excellent interpersonal skills with the ability to communicate with all levels of the organization.
• Strong interpersonal, facilitation, and leadership skills with the ability to interact with various departments/ project teams.
• Excellent, effective, and precise written and oral communication skills; speak clearly and persuasively in positive or negative situations.
• Ability to organize, coordinate, and supervise large projects in a timely, creative, and effective manner.
• Ability to solve problems, analyze, think critically, make good judgments, and make fair decisions.
• Experience in project management, management reporting and analysis and excellent in building, maintaining and working with spreadsheets.
• Able to effectively and methodically implement, manage, monitor, track and/or report on assigned tasks and projects.
• 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.
• Possesses excellent time management and organizational skills; dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
• Excellent leadership, communication, and analytical skills.
• Strong customer service skills and able to work in a diverse, demanding and evolving environment with strong conflict and problem resolution skills.
• Intermediate skills in Microsoft Programs: Word, Excel or Access, Outlook and PowerPoint Access databases.
• Experience in the operation of general office equipment to include PC, fax/copy machine and phone system.

Preferred Requirements:

• Experience working with Medicaid and Medicare populations.

Mental, Physical and Environmental Demands:

• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
• In office working environment.
• May require prolonged sitting- up to 4 hours.
• Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday.

Salary Range: $81,000 - $100,000 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.