Health Coordination Manager RN or SW

The Opportunity: The Health Coordination Manager is responsible for island oversight of staff performing service coordination functions to health plan members identified as having Special Health Care Needs (SHCN) or receiving Long Term Service and Support programs. Manages staff and processes to meet contractual performance standards, health plan goals and quality outcome metrics. Job functions are performed in accordance with the requirements of the QUEST Integration contract and health plan goals and quality outcome metrics. Primary Duties and Responsibilities: Manages health coordination staff responsible for coordinating primary, acute, and Long-Term Services and Supports for those members that have been identified as having Special Health Care Needs. Performs supervisory functions including interviewing, hiring, training, mentoring, conducting performance evaluations, and terminating employees in collaboration with Human Resource staff and Clinical Operations leadership. Ensures service coordination staff meets required educational and/or licensing credentials and applicable training guidelines. Collaborates in establishing, monitoring, implementing and evaluating AlohaCare’s Health Coordination program. Includes updating and maintaining all policies and procedures. Strategically plans and optimizes team resources, ensuring that they are aligned to business needs, initiatives, and performance gaps. Provides oversight of field-based service coordination operations to ensure compliance with all required health coordination activities, established timeframes, and mandatory reports. Ensures alignment and achievement of departmental goals and organizational priorities, including quality, compliance, member outcomes, and cost-of-care targets. Accountable for accurate and timely completion of all required reports, in collaboration with internal departments within AlohaCare. Conducts regular performance monitoring and reporting through audits. Develops, maintains, and continuously improves reporting and dashboards to track progress, monitor team and individual performance, identify trends, and inform leadership decision-making and corrective actions. Ensures accurate and timely completion and submission of required regulatory reports by collecting and validating data, collaborating with internal stakeholders, and maintaining documentation to demonstrate compliance with requirements. Implements the strategic goals of AlohaCare’s QUEST Integration program, translating them into specific, measurable, operating and business plans. Leads efforts and participates in internal and external audits by preparing documentation, ensuring data accuracy and timeliness, responding to audit inquiries and implementing corrective actions to address findings and maintain ongoing compliance. Works with Quality Improvement and Medical Directors to develop and implement metrics that identify and mitigate barriers to improve members’ health care outcomes and goals for independence. Creates and conducts provider outreach initiatives, and/or training in conjunction with AlohaCare’s Provider Relations Department. Develops and maintains strong relationships within the community including State and Federal leaders, providers, vendors, business partners and community alliances. Participates in service coordination staff meetings, interdisciplinary care team meetings and staff manager meetings as required. Coaches health coordination staff and fosters a culture of leadership development. Participates in annual budget development and ongoing monitoring of performance in relation to budgeted goals. Attends QUEST Integration meetings as required. Performs duties of departmental Leads during absences or vacancies. All other duties assigned. Adheres 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: Bachelor’s Degree with emphasis in health care administration, nursing, public health, long term services, and supports field or related field or equivalent combination of education and experience. Minimum of 3 years of experience managing and developing a team. Licensed RN, LSW, LCSW or LBSW in the State of Hawaii. Experience with implementing operational plans to achieve organizational goals. Experience with QExA, QUEST and Medicare programs and working knowledge of managed health care field. Experience with individuals who are low-income or have special health care needs, including: HIV/AIDS, developmental disabilities, medically fragile, older adults, and individuals with physical disabilities. Prior nursing home or experience serving LTSS members in the community. Strong knowledge of community resources including specialty care, behavioral health care resources, inpatient and outpatient and LTSS community resources. Achieves results, builds trust, communicates effectively, customer and quality focused. 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. 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. Experience in the operation of general office equipment to include PC, fax/copy machine and phone system. Requires use of personal mobile devices (Android or iPhone manufactured in the last 4 years) compatible with our application and email systems. Possession of valid driver’s license with access to a reliable insured automobile. TB Clearance First Aid and CPR Certification Preferred Requirements: Master’s degree in social work, Health Care Administration, Long Term Services and Supports, Public Health, or related field or equivalent combination of education and experience. Certification as Case Manager through a URAC-approved entity. Measurable success with operational performance and staff development. Mental, Physical and Environmental Demands: 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: $115,000 - $120,000 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. #J-18808-Ljbffr AlohaCare