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 EPSDT (Early, Periodic, Screening, Diagnostic, and Treatment) RN Coordinator serves as a liaison between the Med Quest Division (MQD) and AlohaCare via the EPSDT Advisory Committee. This role ensures timely access and coordination of services for all members who qualify for the EPSDT Medicaid benefit.
Primary Duties and Responsibilities:
- Coordinates EPSDT program for the health plan
- Attends all EPSDT Advisory Committee meetings chaired by MQD and effectively communicates relevant information back to appropriate business owners within the health plan
- Develops Desk Level Procedures (DLPs) and revises AlohaCare policies and procedures for EPSDT.
- Ensures that all State mandated reports for EPSDT (CMS 416) and dental reports are completed in a timely manner
- Responsible for developing and implementing EPSDT Program and EPSDT Program Evaluation
- Collaborates with Population Health Management and other internal departments for Keiki Wellness and other services
- Represents AlohaCare at community EPSDT functions that are congruent with AlohaCare’s mission and goals.
- Serves as a resource for providers and AC staff to improve EPSDT services.
- Attends coalition meetings of groups related to pediatric health care to remain current with health issues and trends.
- Identifies community and other resources available to meet pediatric preventive health needs.
- Provides annual training to providers/staff on EPSDT.
- Educates providers through mailings and Provider Newsletter articles and Provider Manual.
- Educates and coordinates care for members related to EPSDT services.
- Coordinates member care when requested by PCPs for members who are delayed in receiving EPSDT visits, immunizations, or follow-up.
- Identify members with delayed EPSDT services from state mandated reports or site visits, and follow-up with PCP’s or members.
- Educates targeted members through phone calls as needed.
- Participates in Quality Improvement activities (including HEDIS, CAHPS, etc.)
- Facilitates EPSDT document preparation and maintenance, which enables prompt response to requests for reports concerning EPSDT. This includes clinical studies, regulatory agency audits, and surveys that apply to EPSDT.
- Analyzes specific reports and studies for variance and other statistical data, outlier reporting of findings and recommendations for QI activities related to EPSDT.
- Participates in facility and medical record review audits as needed, particularly for providers who have not met standards in previous EPSDT medical record reviews
- Drives target outreach related to MQD EPSDT requirements (i.e. mass mail outs, communications etc.)
- Coordinates with State and other programs
- DOH - Children with Special Needs
- Transition for EIS (Early Intervention Services)
- Community Integration Services Plus (CIS+)
- Coordination of dental screening and diagnostic services in the thirty (30) days prior to release or as soon as is practicable following release; and
- Targeted Case Management services, which are encompassed in the definition of Case Management in §4.13, in the thirty (30) days prior to release and for at least thirty (30) days following release.
- DHS – State of Hawaii Organ and Tissue Transplant (SHOTT)
- DHS – Foster Care/Child Welfare Services (CWS)
- Dental
- Diagnostic services
- Behavioral Healthcare
- Specialty Care including OBGYN, dermatology, endocrinology, cardiology, pulmonology, and physical/occupational/speech
- Other
- 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, and 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:
- Licensed RN in the State of Hawaii
- Minimum of 2 years of clinical experience.
- Demonstrates ability for assessment, evaluation and interpretation of medical information.
- Understands the concepts of comprehensive pediatric health care.
- Ability to work independently and coordinate with the work of other personnel effectively.
- Demonstrates the ability to work well with members, physicians and other health care providers.
- 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 judgment.
- 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.
- Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
- Working knowledge of Microsoft programs: Word, Excel, Outlook and PowerPoint Experience in the operation of general office equipment to include PC, fax/copy machine and phone system.
- Able to travel within Oahu and occasionally to neighboring islands.
- Access to own transportation for provider site record reviews or meetings
Preferred Requirements:
- Prior medical management or quality improvement experience in managed care
Mental, Physical and Environmental Demands:
Salary Range: $78,000 - $98,000 annually
AlohaCare is committed to providing equal employment opportunity 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.